LIBRARY OF CONGRESS. 



^^.. ixiJTO^ f Xr 

UNITED STATES OP AMERICA. 



ms 



Jlassacfjusetts lEmergcncg antr l^ggiene 
Association* 



SIX LECTUEES 



SCHOOL HYGIENE, 



DELirEKED UNDER THE AUSPICES OP THE 



P^assatl^nsttts ^ntergeittg anb Pggum ^ssoriation 



' TEACHERS IN THE PUBLIC SCHOOLS. 



f 



5 ' 




BOSTON: 

PUBLISHED BY GINN & COMPANY. 

1885. 






y 



Entered according to Act of Congress, in the year 1885, by 

GINN & COMPAHTY, 
in the Office of the Librarian of Congress, at Washington. 



J. S. CusHiNG & Co., Printers, Boston. 



COl^TENTS. 



1. School Hygiene: Its Relations to the Massachusetts 

Emergency and Hygiene Association. By Frank 
Wells, M.D., Vice-President of the Association . . 1 

2. Heating and Ventilation. By F. W. Draper, M.D., 

Assistant Professor of Legal Medicine in Harvard Uni- 
versity 33 

3. The Use and Care of the Eyes, especially during 

School Years. By C. H. Williams, M.D., Assistant 
Surgeon, Massachusetts Charitable Eye and Ear Infirm- 
ary 65 

4. Epidemics and Disinfection. By G. B. Shattuck, 

M.D., Visiting Physician, Boston City Hospital . . 91 

5. Drainage. By Frank Wells, M.D., Editor of the Reg- 

istration Report of the State of Massachusetts . . 113 

6. The Relation of Our Public Schools to the Disor- 

ders OF the Nervous System. By C. F. Folso.m, 
M.D., Physician to Out-Patients with Diseases of the 
Nervous System, Boston City Hospital .... 161 



SCHOOL HYGIENE: 

ITS RELATIONS TO THE MASS. EMERGENCY AND 
HYGIENE ASSOCIATION. 

An Address delivered before the Mass. Teachers' Association, at its 
Annual Meeting in December, 1884:. 

y 

By FBANK wells, M.D., 

Vice-President of the Mass. EMERaENCY and Hygiene Association. 



Allow me, before I enter upon the subject-matter of 
this lecture, to thank you for the privilege, I enjoy to- 
day, of addressing you upon a topic which to all, whether 
directly interested in the education of the young or not, 
must be one of vital importance, — viz., school hygiene, 
— and of laying before you the relations which the 
newly-formed Emergency and Hygiene Association 
bears to it. This privilege I esteem the greater, since 
in no more practical way can the question of school 
hygiene obtain for itself a more widely-spread consider- 
ation, than through a body which exerts such a powerful 
influence as the teachers of Massachusetts. To you, 
|)eachers, are entrusted the care of thousands of children 
of all ages through the greater portion of the working 
hours of the day, and upon you therefore rests some of 
the responsibility, at least, of forming healthy bodies as 
well as healthy minds. Hence any assistance which 
can be rendered to you by those who have made a study 
of school sanitation, must be looked upon by them as a 
privileged duty ; and with this thought I now invite 



2 SCHOOL HYGIENE. 

5*ou to a consideration of the various details of the sub- 
ject, which I trust may not prove wholly uninteresting 
to you. 

To more thoroughly understand the relations which 
the Emergency and Hygiene Association bears to school 
sanitation, it will be necessary, in the first place, to 
briefly refer to the origin of this Society and to the 
scope of its work. In 1883 the Woman's Education 
Association, to which body this community is indebted 
for several very important reforms, recognizing the 
necessity for diffusing useful and practical knowledge 
among the masses, to be used in cases of accident or 
sudden sickness, undertook to provide such instruction, 
by volunteer lectures to both men and women, as would 
accomplish this result. Seven courses of lectures to 
free classes and three to paying classes were given dur- 
ing the first year with such success, that the Association 
was encouraged to increase the number of courses in 
the following year to twenty-five. Of this number, 
eight were given to the police force, and two to the 
members of the fire department. These lectures simply 
gave instruction as to what should be done in cases of 
emergency, before the arrival of the physician or sur- 
geon, with only enough theory added to render the 
practice intelligible. While the work of the winter 
was progressing, the advisory board, which had been 
formed of gentlemen representing various callings, was 
gradually enlarged ; and when it became evident that 
the field of labor had outgrown the limits imposed by 
the rules of the Woman's Association, it was deemed 
fitting that the responsibilities should be assumed by a 
new organization. Consequently the Association now 



SCHOOL HYGIENE. 8 

known as the Massachusetts Emergency and Hy- 
giene Association was formed, the work of which it 
was deemed very desirable should be extended through- 
out the State, and be made to include instruction in an 
increased numoer of branches of useful knowledge. A 
transfer of its duties was then made to the new Society 
by the originators of the first scheme, and various com- 
mittees were appointed to take charge of the details 
incident to the various departments. These depart- 
ments provide for the extension of the work throughout 
the Commonwealth, by encouraging the formation of 
branch associations ; for the instruction of the better 
classes, who are able to pay a fee ; for courses of lec- 
tures to be delivered to railroad employes, mill operatives, 
stevedores, and the like ; to the members of the police 
and fire departments; to the militia; to missions and 
institutions ; and upon school hygiene, to teachers, pupils 
in the normal schools and such others as may be 
interested in this subject. 

This latter branch of the work was thought i,o be one 
of great importance, and one which, taking into consid- 
eration the standing of those to whom the lectures 
would be particularly addressed, — viz., the teachers in 
the public schools, — might prove to be far-reaching in 
its usefulness. To many of you the subject of school 
hygiene may be, and undoubtedly is, familiar, while to 
others it may never have been presented in its proper 
light; but to all, we have a hope that whatever instruc- 
tion we may be able to give may be of some use, not 
only to yourselves directly, but also through you to the 
many children who are entrusted to your care. 

Why is this work so important and so necessary? 



4 SCHOOL HYGIENE. 

Simply because hygienic abuses exist, and hence reforms 
are needed ; because a large number of children die 
every year from contagious diseases, which have been 
unrestrainedly disseminated by the public schools ; be- 
cause some schoolhouses are badl}^ located ; many have 
serious imperfections in their systems of ventilation and 
heating, with overcrowding in the class rooms and in 
the recitation rooms, and with poor drainage and an 
impure water supply. Because, moreover, owing to 
poor light improperly directed, and to a close application 
to study under improper regulations, near-sightedness 
is found to be progressively increasing, in a direct pro- 
portion to the advance of the pupils into higher grades; 
and finally, because the high-pressure sj^stem of study 
of the present day leads to a breaking down of the ner- 
vous forces, to consumption, and to certain other dis- 
eases, which physicians are constantly called upon to 
treat. 

That this picture has not been too highly colored, 
that these defects do actually exist, will become evident 
to all who enter many schoolhouses during study hours. 
Greeted by odors, which are sometimes so aggravated 
that they become wellnigh unbearable, in a temperature 
altogether too high, the visitor will be struck with the 
pallor and evident lassitude of certain scholars, who are 
vainly endeavoring to accomplish their allotted tasks ; 
he will notice that some are sitting directly facing the 
light, and, bending their bodies in a constrained posi- 
tion, are studying or writing with their books held but 
a few inches from their eyes ; he will see some pupils 
not recovered, but simply in a state of convalescence, 
from diseases from which they have been suffering ; and 



SCHOOL HYGIENE. 5 

he will see others with flushed faces and further symp- 
toms, indicative of affections from which they are about 
to suffer. He will recognize all this, and oftentimes 
much more, if he makes a thorough inspection of the 
building and the premises. 

These, then, are the causes which have lead sanita- 
rians to devote so much of their best thought to the 
hygiene of schools, and it is to these causes that I pro- 
pose briefly to allude. 

Situation. — In consideration of the well-known fact 
that children are highly susceptible to morbid influences, 
it is very essential that the schoolhouse, in which they 
pass so much of their time, should be hygienically 
located and built. Consequently, it should never be 
located near unwholesome nor noisy trades and indus- 
tries. Above all, it should be so placed that each room 
should receive as much sunlight as possible, particularly 
in our northern climate. I say as possible, since in 
many cities the streets are so laid out that this desider- 
atum is difficult of accomplishment. Architectural 
effects, which the sesthetic demands of our times seem 
to call for to an unwarrantable degree, should always 
be made subordinate to the principle of abundant sun- 
light, and consequently should never be allowed to 
interfere with a sufficient number of large, serviceable 
windows. 

As dampness — conducing as it does to rheumatism, 
catarrh, and consumption, and contributing to the pro- 
duction of other affections — is dangerous to health, 
care should be taken that the schoolhouse is placed 
upon a dry soil (this applies of course more to the coun- 
try districts), in a locality apart from swamps, ponds, 
and excessive tree growth. 



6 SCHOOL HYGIENE. 

Its cellars should be made impervious to dampness by 
concrete or asphalt floors and cemented walls. The 
condition of the cellar is one of great importance, for 
often it proves to be the source from which disease sud- 
denly breaks forth. Often dark, as frequently damp, 
furnished with water-closets, and serving as a receptacle 
for all kinds of rubbish, and as a place in which to hang 
the outer garments, its vitiated air being frequently 
forced, by pressure from without in cold weather, into 
the upper rooms, the cellar proves to be a very efficient 
factor in the production of severe illness. 

Ventilation and Heating. — In discussing this subject, 
I start with the broad assertion that there is scarcely a 
schoolhouse anywhere, in which the ventilation is suffi- 
cient for protecting the health of the scholars, nor in 
which the system is properly designed. This is certainly 
criminal, and those who are responsible for this grave 
sanitary defect should be held accountable for the injury 
to health which invariably ensues from it. Every one 
can understand that it is unpleasant to enter an illy 
ventilated apartment, and that, after a few minutes, 
headache, nausea, and lassitude may result from the 
vitiated air. But there are very few who realize that 
great debility and impaired digestion ; that severe colds, 
consumption, and other diseases of the respiratory or- 
gans may be caused, and "the development of glandular 
enlargement and scrofula, in their more severe forms, 
favored by confinement in the foul atmosphere of an 
unventilated room." The importance of good ventila- 
tion cannot be too deeply considered, and the best 
means for providing it must always receive the at- 
tention of sanitary bodies. The idea uppermost in 



SCHOOL HYGIENE. 7 

the minds of many persons — I will not say educated 
persons, although a visit to some of the schoolhouses 
might convince a person contrariwise — the idea promi- 
nent with many is that, to secure good ventilation, it is 
only necessary to open a window. This surely admits 
a copious supply of air, but it provides no method for 
the passage outwards of the foul air, which is one of 
the very essentials of good ventilation. That is, perfect 
ventilation consists, not only in the admission of pure 
air, but in the drawing out of that which has become 
vitiated. It aims primarily in getting rid of that odor 
which is as characteristic of the school-room, as that of 
the hospital is to it. In banishing this a great gain is 
made, for a sense of freshness in the atmosphere indi- 
cates its actual purit}^ Much can be accomplished in 
this direction by a judicious supervision on the part of 
the teacher, by insisting upon the personal cleanliness 
of the pupils. I think that valuable assistance is being 
rendered in this particular, in our large cities, by those 
charitable organizations, which by domiciliary visits in- 
culcate, among other things, the principles of health in 
the families which they have under their charge. Over- 
garments should never be hung in the school-room, nor 
in any place in a dark, unventilated closet or wardrobe ; 
since reeking as they often are with the odors of cook- 
ing, and bearing, it may be, something more injurious 
still, such receptacles condense the effluvia, and tend 
to the concentration of what may be the germs of dis- 
ease. If the clothes are hung in the basement, care 
should be taken that it is not in a position, from which 
the odors from them may be carried upstairs by the 
furnace pipes. This may seem to you a small matter 



8 SCHOOL HYGIENE. 

upon whicli to dwell; but when I tell you that in one 
of the most expensive schoolhouses built in this city, 
no provision was found to have been made for the care 
of the outer garments, and when you reflect that, under 
the combined influence of dampness, darkness, and non- 
ventilation, disease germs live and have their being, you 
will agree with me that this apparently simple question 
becomes an important one. 

The first problem to be considered is that of fresh air. 
To solve this problem many theories have been ad- 
vanced and many plans devised, a discussion of which 
does not properly come within the province of this ad- 
dress. I wish, however, to present to you a few general 
propositions, in order that you may fully comprehend 
what it is desirable to accomplish. 

First, what is meant by fresh air ? It is air in which 
there is no perceptible odor, which is not overheated, 
which is not introduced through a channel of communi- 
cation, such as the cold-air box of the furnace, com- 
mencing in the neighborhood of cesspools or of decaying 
material of any kind, or which originates in the cellar ; 
and, finally, it is air which is not too infrequently re- 
newed, nor that of an overcrowded nor unclean room. 

I have said that fresh air is not overheated air. Now, 
overheating is one of the great hygienic evils so fre- 
quently met with in the school-room, — an evil, because 
it is very potent in the causation of colds, and, more- 
over, leads to an over-stimulation of the circulation in 
the brain and nervous centres, thereby producing defec- 
tive vision, headaches, and nervous irritability and de- 
pression. What constitutes overheating it is somewhat 
difficult to determine. One thing, however, is very cer- 



SCHOOL HYGIENE. 9 

tain, and that is, that the degree of heat should never 
be regulated by the feelings of the teachers, among 
whom so many individual idiosyncrasies exist, nor by 
the toleration of it which long habituation always pro- 
duces. Therefore, there should be a standard, which 
standard is variously estimated. Morin says 59°, Ficker, 
64", and Varrentrapp, 65f° F. Americans, as a rule, 
demand a higher temperature than the Europeans, and 
consequently a proper standard for them is estimated at 
between 65° and 68° F., which should in no case in the 
school-room be increased above 70°. If at this temper- 
ature there is a feeling of cold, it is because the circula- 
tion of the blood is not active enough, the pupils being 
confined too long at their tasks without exercise. You 
cannot make them warm by raising the temperature, or, 
if you succeed in so doing, it will be at the expense of 
headaches and still greater debility. Trust, then, to 
the thermometer rather than to your own feelings, and 
remember that the time to correct bad habits in this 
direction is at the commencement of the term, when 
the pupils return to school with their systems invigor- 
ated by their vacations. For if the children, as well as 
the teachers, become accustomed to an elevated temper- 
ature, a preference for it is generated, which is very 
difficult to eradicate. 

There is one more point upon which I cannot forbear 
speaking before leaving this part of the subject, and that 
is the erroneous practice of lowering the windows at 
the top in order to reduce the temperature, thereby 
admitting a current of cold air upon the heads of the 
children. This sudden change of temperature is a pro- 
lific cause of colds, bronchial affections, or more serious 



10 SCHOOL HYGIENE. 

pulmonary difficulties, as may be easily believed when 
it is considered that, in the short period of three-quarters 
of an hour, this procedure has been known to lower the 
mercury in the thermometer 16° F. at the desk level. 

Allusion has been made to overcrowding as a cause 
of a vitiated atmosphere. What constitutes overcrowd- 
ing, however, is variously estimated, — the standard 
requirements as to area, according to the different ob- 
servers, ranging from 300 cubic feet of space for each 
scholar, to the altogether too small a provision of 70 to 
100 cubic feet, according to ages. Taking into consid- 
ation, however, economy of space and other problems 
of construction, the best authorities in this country 
express a preference for 250 cubic feet, which would 
necessitate a room 25 feet by 30, and 13| feet high, to be 
occupied by forty scholars. Unfortunately, though, we 
do not often find less than fifty scholars assigned to one 
room, which reduces the space for each to 200 cubic 
feet. Still it is a matter for congratulation that there 
is a growing tendency to improvement in this particu- 
lar. Certainly, upon looking back to my own school 
life in the Boston public schools, thirty years ago, I am 
rejoiced to see that some of the mistakes of overcrowd- 
ing made in those days have been corrected, although 
there still remains a great room for additional improve- 
ment. 

Having now discussed briefly what fresh air is, or 
rather what it is not, it remains for us to consider how 
to admit it into a room and in what quantities, and how 
to get the bad air out, — in other words, to study for a 
few minutes the real theory of ventilation. 

First, the quantity required. This amounts to as 



SCHOOL HYGIENE. 11 

much as will reduce impure air to a standard of relative 
purity. It was formerly considered that carbonic acid 
was a specifically poisonous gas, but now cheniistry 
teaches us that it is only dangerous by its interference 
with respiration. But the presence of carbonic acid gas 
in a room is an indication of the existence also of other 
gases and bodies which are injurious to health, and as 
the amount of the former bears a tolerably accurate 
relation to that of the latter, we have come to look 
upon its chemical determination in the air as an indica- 
tion of its impurity. But all good air contains about four 
parts of carbonic acid gas to 10,000, which amount may 
be slightly increased by the admixture of human breath, 
without rendering it close and offensive. Practically 
each person vitiates 3,500 cubic feet of air in an hour, 
and hence this amount must be drawn out in the same 
length of time, and its place supplied by an equal quan- 
tity of pure air. This is equivalent' in round numbers 
to 60 cubic feet per minute for each person, which is 
the standard requirement, according to Dr. Lincoln, for 
houses permanently occupied. For those, however, — and 
such are schoolhouses, — which are occupied at intervals 
and thoroughly aired in the meanwhile, 30 cubic feet 
per minute is sufficient. 

It is not asserted that a standard which falls slightly 
below this would be dangerous to health, but if a much 
smaller allowance should be provided, as in the case of 
some schoolhouses, then evil results would be sure to 
follow. 

The next question to be discussed is how the impure 
air shall be removed. In our climate the only efficient 
way (I exclude open fires as not practical in the school- 



12 SCHOOL HYGIENE. 

room) is by means of flues, properly constructed and 
judiciously managed. Unfortunately this is not always 
the case ; in fact, I may almost say it is seldom the case. 
Go into certain school-rooms, and, against the evidence 
of your sense of smell, you may be told that the ventila- 
tion must be good, because, forsooth, there is a ventilat- 
ing flue. True, there may be one, but just as truly it 
may be as worthless for its intended purposes as though 
it never existed, — nay, more so, for, unless it is so con- 
structed that it will create a current upward through it 
of warm air, it can easily serve as a channel downward 
for a stream of cold air. 

A flue, to fulfil its mission, must draw well, and in 
order that it should do this, it must be as straight and 
as vertical as possible. It must be smooth, continuous, 
and opening upwards out of doors ; above all, warm — at 
least warmer than the outside air — since otherwise the 
current will be inverted; protected in cold places, so 
that it shall not lose its heat ; and not located in the 
outer wall. 

With such a flue (one for each room), having its 
opening large enough, and, on account of the sources of 
impurity being more frequently found at the lower 
levels, situated near the floor, the first problem of good 
ventilation will have been solved. The second problem 
remains to be considered, viz., the methods of introduc- 
ing pure air to replace the bad air which has been 
aspirated by the ventilating shaft. The usual method 
of accomplishing this is by means of the cold-air box 
of the furnace, the furnace being the common means 
employed for heating, although some prefer the steam 
coil, which furnishes heat by direct radiation. But the 



SCHOOL HYGIENE. 13 

great objection to this method is that it does not pro- 
vide a proper amount of fresh air, unless arranged in a 
manner presently to be described. A furnace is like- 
wise open to the same objection, since it is very apt to 
be over-driven, thereby furnishing a quantity of hot air 
and carrying up tlie direct products of combustion into 
the rooms. If care, however, is taken in the construc- 
tion and in the management of a furnace, so that its 
channels of inlet and discharge are large enough to give 
out a proper volume of warm but not hot air, the above 
objection will be removed. In other words, if it is 
remembered that a furnace requires brains as well as 
fuel to run it, it will always prove an efficient method 
for supplying one factor of a proper ventilation. 

Where stoves are used, they should always be guarded 
by a metal screen, or jacket, as it is technically called, 
as a protection against heat, and for the additional pur- 
pose of ventilation. These screens should be consider- 
ably wider than the stove, which they completely encircle, 
extending above it a short distance, and either fastened 
to the floor or, as some prefer, reaching only as far as 
the bottom of the stove and there fastened, or partially 
encircling it, leaving its door exposed. A shaft is lead 
through the outer wall of the house directly under the 
stove, through which fresh air enters, and, being brought 
into close proximity with the stove by the screen, passes 
upward warmed^ thus fulfilling one of the requirements 
of good ventilation. If the stove is placed near a win- 
dow, the screen can be made to enclose it on all sides, 
excepting that towards the window, which, being opened, 
supplies the air to be warmed by the stove, before pass- 
ing upwards in the general current. This is a very 



14 SCHOOL HYGIENE. 

simple and cheap method of introducing fresh air into a 
room, and one for which I am indebted to a late Report 
of the Michigan Board of Health. This same system 
may be applied to the steam coils, thereby relieving 
them of the objections which have already been men- 
tioned, although there still remains the difficulty of 
regulating the heat, furnished by them, in warm weather. 

No matter what system of heating is used, however, 
whether it is the steam coils, furnaces, or stoves, it is of 
vital importance, as has already been intimated, that 
the air supply should be derived from pure sources. 
Great carelessness is shown in regard to this, and too 
often impure air — air loaded with malarial poison, 
which settles to the lower atmospheric levels, or with 
the products of decomposition — is taken in through 
the shafts, thereby causing severe sickness, and more 
than defeating the objects for which these shafts were 
constructed. 

No system of flues, however constructed, can do away 
with the necessity of thoroughly airing the rooms, by 
opening the windows at regular intervals. The thirty 
cubic feet of fresh air per minute for each scholar, which 
has been mentioned as a sufficient supply for rooms 
occupied for short periods, will not keep their atmos- 
phere pure for an unbroken session of two or three 
hours. Hence it becomes necessary to open the win- 
dows occasionally for a few minutes (once an hour is 
none too often in average weather), while the scholars 
are kept warm by gentle exercise. The recess should 
be utilized for the same purpose, while the rooms should 
receive a thorough airing after each session. 

Perhaps one of the most, if not the most, efficient 



SCHOOL HYGIENE. 15 

method of procuring a free admission of good air is the 
window-board, which is undoubtedly familiar to you all. 
By this arrangement the air current is directed upward, 
and has a chance to become heated before it descends 
to the lower levels. A wider board, placed one or two 
inches from the sash, may be used in the milder weather 
of the spring or autumn. 

There is one more point to which reference should be 
made in this connection, and that is the faulty construc- 
tion of schoolhouses, which provides for, it may be, 
sufficiently large and well-ventilated class rooms, but 
arranges recitation rooms totally deficient in even decent 
ventilation. Into these rooms, which are generally 
small, are crowded a much larger number of pupils than 
can obtain the proper amount of fresh air, and in this 
vitiated atmosphere they are obliged to remain, without 
relief, until the recitation hour is over. Economy of 
money and of space is not always an economy of health ; 
hence such mistakes as these should be carefully avoided. 

Drainage. — This subject is so vast and important, 
that but little more than an allusion to it can be made 
in this address. A good system of drainage is one of 
the greatest scientific advances of modern times; a poor 
one worse than none. For perfect drainage carries off 
efficiently and quickly, before decomposition has com- 
menced, sewage which was formerly conserved in close 
proximity to dwellings. An imperfect sj^stem, on the 
other hand, furnishes channels of direct commuincation 
between the interior of our houses and the filth of the 
sewers, through which, sewer-gas, that composite emana- 
tion from decomposition, enters to undermine the health 
of the inmates. But the term sewer-gas, in its sanitary 



16 SCHOOL HYGIENE. 

sense, is not confined to the products of the sewers 
alone, but it inchides, according to Waring, the emana- 
tions from waste matters undergoing decomposition in 
the absence of light and air, and in the presence of 
water, whether in a sewer, house drain, cesspool, privy 
vault, a compost heap, or in a wet, unventilated cellar. 
In cities and towns which have a sj^stem of drainage, 
this gas is found, of course, more frequently in the 
sewers and drains. Children, as has been said be- 
fore, on account of their more delicate organizations, 
are more susceptible to morbid influences than are 
adults. Hence our first care should be that the drain- 
age of the schoolhouses — and by this term is meant the 
disposition of all decomposable material — should be as 
perfect as possible. How often is this not the case ; 
how often do we find sclioolhouses — happily growing 
less in number — provided with imperfect methods of 
ventilating the drains, and some with sole dependence 
on those unreliable agents when used alone, — traps. 

With certain defects in the drainage of schoolhouses, 
and particularly of the older ones in the larger cities 
and towns of the State, we are immeasurably better off 
in this respect than are those Avho live in the smaller 
places. For in the cities are enjoyed the privilege of 
health boards, and a ready access to the literature and 
to lectures upon the subject to enable us to rectify the 
evils. But in the country districts the case is different, 
and it is this latter consideration which, up to the pres- 
ent time, has been too long neglected. There are school- 
houses in the smaller communities throughout the State, 
which in the matter of hygiene are a disgrace to civiliza- 
tion ; in which filth actually runs riot ; with dirty floors, 



SCHOOL HYGIENE, 17 

uncleaned stairs, and disgusting privies ; and from which 
consequently typhoid fever, as well as the other so- 
called filth diseases, may originate. 

In this connection I desire to say one word in regard 
to an unsuspected cause of disease, which never, I 
believe, has been thoroughly discussed. I refer to the 
wells of schoolhouses, situated in remote country dis- 
tricts, and only used during the school terms. During 
the vacations no water is taken from them, and hence 
it becomes stagnant. In the autumn, when the term 
commences, the water in this condition is drunk by the 
scholars, thereby, either alone or in connection with the 
unsanitary condition of the surroundings, tending to 
produce sickness, which may be wrongly attributed to 
the houses in which the children dwell. It is a satis- 
faction to know that these matters are receiving due 
attention from the State Board of Health, to which 
Board we are indebted for many wise sanitary reforms. 

Privies, as commonl}'- constructed, are abominations, 
since they are exceedingly dangerous to the health of 
the children. In many country schools they are seldom 
cleaned out, and hence render the atmosphere impure, 
and become dangerous to the water supply. They 
should never be placed, when avoidable, in the same 
building as that which contains the school-rooms. If 
necessity compels their location in the cellar, care 
should be taken that they are placed in an apartment 
remote from the furnace, and one which is well venti- 
lated by means of windows opening to the outer air. 
No matter where they are situated, however, they must 
be frequently cleaned out and thoroughly disinfected, in 
which case they are reduced to their minimum of 
danger. 



18 SCHOOL HYGIENE. 

Eyes. — As well recognized as it is that sanitary- 
errors are productive of ill health, it is not so well 
known as it should be, that during school life defects in 
vision, particularly that form known as myopia or short 
sight, are progressive, and are j)roduced by the same 
hygienic short comings. It is said that savage tribes 
are not short-sighted, and this as a rule is true of a 
child when he commences his education. But as the 
child is advanced from class to class, it is found in vari- 
ous parts of the world, such as Germany, Russia, 
France, Switzerland, and the United States, that abnor- 
mal vision correspondingly increases. This evil has not 
as yet become so pronounced, however, in this country, 
since more care is taken with the length of the study- 
hours, and with those devoted to exercise and recrea- 
tion. But even in America, the fact of increasing near- 
sightedness is so striking, that it is incumbent upon us 
to seek the causes in order that they may be removed. 
Young children, who are near-sighted, are undoubtedly 
so through inheritance, for the affection is, according to 
the best authorities, transmissible. In the case, how- 
ever, of those who commence school life with normal 
vision, and become short-sighted afterward, a number 
of conditions, all relating to the hygiene of schools, con- 
tribute to the result. For one cause, we have poor 
light, or light improperly directed. Cohn states that 
the rate of near-sightedness increases in proportion to 
the poorness of the light, and the narrowness of the 
street in which the schoolhouse stands. The light 
should never come from directly in front ; blackboards 
should not be placed between two windows, nor in 
close proximity to one. The best light is that which 



SCHOOL HYGIENE. 19 

comes over the left shoulder. Other causes are found 
in a bad position of the body, overheated rooms, im- 
perfect ventilation, wet feet, indigestion, peculiarities 
of diet, excessive length or severity of study without 
relaxation, and lack of out-door exercise, all which 
evils are, according to Dr. Loring, "provocative of a 
certain laxity of tissue and want of resistance in the 
investing membranes, which finds its expression in the 
eye in a distension, which is in fact myopia." The 
remedy for this evil is suggested by a knowledge of the 
conditions which produce it. This knowledge alone 
should cause us to seriously consider whether, at the 
present day, there is not too much pressure of study, 
under unfavorable conditions, being forced itpon school 
children, particularly between the ages of ten and 
fifteen, which is the great period of life for the develop- 
ment of short-sightedness, a period, too, when the body 
is developing most rapidly. That we as a nation shall 
ever be reduced to the myopic condition of the Ger- 
mans, I do not believe ; and yet the statistics of the 
affection in America should give us abundant food for 
reflection, in order that we may cry a timely halt to its 
onward march. 

Omitting from lack of time a consideration of the 
subject of school desks and seats, and also that relat- 
ing to the spread of contagious diseases by the schools, 
the foregoing reference to over-pressure leads us 
naturally to the discussion of the last topic of this 
lecture, — a topic which has become one of vital impor- 
tance, involving, as it does, not only the well-being of 
the child, but also indirectly that of the nation. I 
refer to the intelligent care of the nervous system. 



20 SCHOOL HYGIENE. 

Dr. D. F. Lincoln has said, very truly, that to a 
child in good health nothing is more delightful than the 
properly directed use of his mental faculties. Properly 
directed, I emphasize, for unless the methods of study 
are so regulated, that the mind is not forced to assume 
a task before it has been sufficiently well developed to 
grasp and comprehend it ; unless its action is spontane- 
ous and not forced, the child partakes of its mental 
food with no appetite for it, a mental dyspepsia is pro- 
duced, the bodily health suffers — the system is a bad 
one. As a rule, I think that a child in this country 
is forced beyond its physical capabilities and its develop- 
ment. This is particularly true in the case of nervous 
children (I»use the common term), of which class there 
is unfortunatel}'" too large a number in the New Eng- 
land States. The charge brought against our Ameri- 
can system of education, viz., that we endeavor to 
accomplish too much within a given period; that we 
impose upon the child too many subjects of study at 
one and the same time, is a just one. This fact was 
recognized some years ago in the Harvard Medical 
School, and the change, which was consequently inaug- 
urated, has resulted in a more thorough education, and 
in more healthy minds to pursue its advantages. 

Physicians are called upon every day to treat young 
women, who have been sacrificed to the American 
fetich of overwork. This is not entirely the fault of 
school-boards, nor of school-teachers; the blame must 
often rest with the scholars themselves, who, in their 
anxious desire to push forward, in their eager haste to 
be out in the world " doing something," as the expres- 
sion is, overtax and overstimulate their brains, and 



SCHOOL HYGIENE. 21 

come to realize too late that festina lente is as truly- 
applicable to the brain as to the body. Do any of you 
realize what the statistics of mortality from brain disor- 
ders are in this Commonwealth ? Pray listen to them, 
for they are highly instructive. I quote from the forty- 
second Registration Report of the State of Massachu- 
setts, which records that 3,562 deaths occurred from dis- 
orders of the brain in 1883, as compared with 1,386 in 
1860. In other words, during this period, the mortality 
made the astonishing advance of 156.9 per cent, as against 
an estimated increase in the population of 61.2 per cent. 
Over the year 1882, the advance equals 4.9 per cent, 
while the population is estimated to have increased 2.2 
per cent. In the period of twenty-four years, of which 
mention has just been made, apoplexy advanced 229.4 
per cent in its mortality, paralysis 162.6 per cent, and 
insanity 157.7 per cent. Moreover, there seems to have 
been an increasing fatality from brain disorders in the 
period of life under forty. 

As frightfid as the contemplation of these statistics 
is, more serious still is the realization of the fact, which 
a careful study of the subject for many years obliges 
me to affirm, that the cause of this advancing mortality 
must be sought, not entirely in the worries and cares of 
adult life, but to a certain extent in the schools, in the 
ignorance of the needs of the nervous system so com- 
monly to be found there. Arriving independently at 
this conclusion some time since, I am glad to be now 
supported in it by such a keen observer as Dr. Crichton 
Browne of London. This writer in a recent report 
upon over-pressure in the English schools says, that the 
great increase in suicide has been coincident in time 



22 SCHOOL HYGIENE. 

■with the modern extension of education, and as being 
most prevalent in regions where the education is most 
widely spread. Besides this evil, he alludes to the fact 
that hydrocephalus and cephalitis — both brain disor- 
ders — have become relatively more common within the 
last twenty-four years, during the school age, and that 
somnambulism and somniloquency exist in considerable 
proportion, and are more or less associated with school 
work. 

These disastrous results are reached partly by over- 
work, which is defined as an absolute excess of mental 
exertion, and partly by strain, or work at times of 
fatigue or under an unusual excitement. The one 
great mistake, which to a physician's mind is made, con- 
sists in prescribing, particularly in the advanced classes, 
courses of study which require too many of the child's 
waking moments to accomplish. Just how many hours 
a day a child should study is very difficult to fix by any 
general law. The most intelligent writers upon the 
subject give it as their decided opinion, that under the 
age of twelve, four hours of daily study are all-suffi- 
cient; below ten years, three or three and one-half, 
and below seven years, two and one-half to three hours. 
At no age, however, should the time required for the 
completion of the daily tasks exceed five or six hours, 
and this is especially true during the period of rapid 
growth and sexual development. The experience of 
the best teachers proves that primary-school scholars 
cannot be kept at real work more than three hours a 
day, without producing a mental and physical strain. 
Hence, the system by which young children are kept in 
school the same number of hours as those who are older, 



SCHOOL HYGIENE. 23 

is wrong from every point of view, and should demand 
serious attention. 

I haye alluded several times in the course of this 
lecture to certain periods of life, during which hy- 
gienic errors become particularly dangerous. To 
these periods it may not be wholly uninstructive at 
this point to more fully refer. There are four epochs 
in the life of the child and youth, which mark physio- 
logical changes in their nervous systems. The first is 
when the infant arrives at the period of primary denti- 
tion ; the second, the commencing irruption of the per- 
manent teeth ; the third, the age of puberty ; and the 
fourth, the completion of dentition, the so-called cut- 
ting of the " wisdom teeth." The altered condition of 
health, so often noticed in children at these different 
stages, is but the expression of constitutional changes 
going on, of which changes the irruption of the differ- 
ent groups of teeth are but the symptoms. The 
dangers of the first period — the cutting of the first 
temporary teeth, particularly if this occurs during hot 
weather — are usually recognized, and the infant is 
carefully tended in order to avoid any evil results. But 
the perils attendant upon the other epochs which have 
been mentioned are not so commonly realized. These 
perils are not certainly as great as in the early stages of 
life, on account of the more advanced state of develop- 
ment of the nervous system ; but still they may be, and 
often are, sufficiently pronounced to leave a lasting 
impression upon the child's future health. For it is 
just at these periods, and particularly at the age of 
puberty, that impaired digestion, disorders of the brain 
and nervous centres, and pulmonary affections may be 



24 SCHOOL HYGIENE. 

engendered, unless strict attention is paid to all hy- 
gienic details. Hence it is that physicians lay so much 
stress upon the vast importance of exercising, a wise 
care both for the body and the mind at these times, 
since habits, whether physical, mental, or moral, which 
are then formed, are very likely to become permanent. 

Not only should the hours of study be curtailed 
within hygienic bounds, but strict attention should also 
be paid, that a young child is not confined too long at 
any one study. Mr. Edwin Chadwick, in his work on 
" Half-Time System in Education," says that a child 
from six to seven years old is able to attend to one 
lesson for fifteen minutes only ; from seven to ten, for 
twenty minutes ; from ten to twelve, about twenty-five 
minutes ; and fi'om twelve to sixteen, about thirty min- 
utes. In England the half-time system provides for 
three hours attendance in school, and for the rest of the 
working hours, employment in factories, in shops, and 
on farms. Over one hundred thousand children are 
thus taught, and it has been found that they make as 
much progress as those who attend school six hours a 
day. I look with great interest to see some such plan 
extensively carried out in this country, — a plan which 
I am certain will result not only in the improvement 
of the physical condition, but also in a more practical 
education for those who will be obliged to earn their 
livelihood by the labor of their hands. 

In considering this subject of the proper number of 
hours for study, it has always seemed to me a radically 
wrong principle, that, in those schools which hold but 
one daily session, this session should be made to divide 
the working day so unequally. With attendance at 



SCHOOL HYGIENE. 26 

school from nine o'clock until two, the pupils seldom 
reach liome before half past two, at which time, fatigued 
by long hours of study and confinement, they immedi- 
ately sit down to a meal, which, under the above condi- 
tions, cannot be properly digested, which is also brought 
too near the one which follows, and which consequently 
in the short days of the year leaves but little time for 
the proper amount of out-door exercise. Another 
minor question in this connection, though not of minor 
importance, is that of school lunches, an improper atten- 
tion to which essential to health has produced, and is 
producing, more harm than is realized in schools having 
but one session. Some scholars bring improper, indi- 
gestible materials to school for lunches, and others 
bring none at all. Good health and good work under 
these conditions are impossible. In certain cases, to be 
sure, milk is sold to the scholars by the janitor ; but 
many do not like milk, and some cannot drink it. A 
much better plan, therefore, would be to provide some- 
thing warm to eat for those to whom milk is distasteful. 
In the Institute of Technology this plan has been tried, 
and has resulted in a marked improvement in the 
health of the pupils, and consequently in the character 
of their work. One more point : — the school committee 
of Boston, with a wise forethought, causes an alarm to 
be sounded in stormy weather as a signal for one ses- 
sion. But another precaution is needed, and that is 
the sounding of the same alarm, when the weather in 
summer is oppressively hot. Apart from the dangers 
to those children who have to take long walks to school 
under a blazing sun, extreme heat causes languor and 
debility, during which mental work becomes arduous, 
and hence improper. 



26 SCHOOL HYGIENE. 

The system of rank and rewards for the attainment 
of a certain arbitrary standard, exhibitions and exami- 
nations which, properly conducted, furnish a stimulus 
which may be desirable for boys, are for girls, I appre- 
hend, by no means unproductive of harm. In the case 
of the latter, the system tends to the development of 
nervous emotions, such as fear of failure, over-excitation 
at success, to a much greater degree than with boys, — 
emotions which lead to the impairment of the ner- 
vous forces, thereby provocative of disease. Dr. H. I. 
Bowditch says, "I have seen not a few patients — 
scholars — who under the violent stimulus put upon 
them by an approaching examination or exhibition for 
rank or for prizes, have sunk immediately after such 
extra intellectual labor, wholly prostrated in mind and 
body ; and where I have seen them, far advanced con- 
sumption was plain. Such cases are utterly hopeless." 

No higher duty devolves upon teachers, parents, and 
physicians, than the earnest consideration of this ques- 
tion of the proper education of girls and young women. 
But how often is this subject lost sight of; how often 
not only in our schools, but in all occupations in which 
women are employed, do we see them subjected to the 
same routine, the same discipline, the same degree of 
close application, and to an equal amount of physical 
and mental fatigue, as are boys and men. This is all 
wrong, since it tends during the school years to a con- 
dition of health which may be productive of chronic 
invalidism and nervous exhaustion thereafter. 

I do not intend by any means to assert that all girls 
who graduate from our advanced schools leave them 
in poor health; but I do affirm that while the robust 



SCHOOL HYGIENE. 27 

and strong may pass through the ordeal unscathed, the 
delicate, the over-ambitious, and those who have in- 
herited tendencies to disease, cannot escape with im- 
punity the too common results of the present sj'stem 
of education. In the light of experience, the question 
which we should all put to ourselves is, whether the 
amount of school work has not reached its utmost 
limits, perhaps overstepped these limits, consistent with 
a proper regard for the health and well-being of the 
pupils. I think that it has. 

It is not alone, however, in the pupils that we see 
this evil outcome of the high-pressure system. The 
teachers themselves, particularly if they are females, 
too often break down under the strain. As sad as it is 
to see educational mistakes exemplified in the young, 
just as sorrowful perhaps it is to contemplate the effects 
of overwork upon those, who, in their obligations to 
push forward their pupils to a successful completion of 
the allotted yearly tasks, are forced to perform an 
amount of daily work, which many men in active busi- 
ness-life could not long endure. 

If a teacher could or would, as a daily habit, procure 
the requisite amount of exercise in the open air, and 
give to herself — I say to herself, for these remarks are 
addressed particularly to you lady-teachers — sufficient 
intermission at noon ; if she would eat a proper meal 
before going to school, without hurry, or anxious haste 
to assume the routine, work of the day ; if she allows 
herself pleasant recreation, and if, finally, she is not 
obliged to carry the burdens of her school duties home 
with her, then the number of hours required for the 
faithful performance of her tasks in the school-room 



28 SCHOOL HYGIENE. 

would not, as a great rule, be productive of harna^ 
provided that the same school-room is in a good sani- 
tary condition. If, however, she should neglect these 
hygienic precautions, or if, with or without a disregard 
of them, she is obliged to take to her home detailed 
tasks ; if there, instead of the needed rest, she is forced 
to prepare averages, reports, and examinations; in other 
words, if her brain is kept in ceaseless activity from 
Monday morning until Saturday night, as I firmly 
believe is too frequently the case, particularly iu the 
spring of the year, when the system is more or less 
enfeebled, then surely she is overworked, and her 
occupation becomes a burden. 

Intimately associated with the subject of the nervous 
system, is that of exercise, since upon a proper amount 
of this physical diversion depends to a great degree 
the measure of health. This is a particularly impor- 
tant consideration for girls, who, as a class, do not 
possess the same opportunities for the development of 
their physiques as boys. Both sexes, however, should 
have some sort of systematic exercise provided for 
them by the schools, especially as in cities and larger 
towns the march of improvement has curtailed the 
facilities for out-door sports and exercise. This course 
need not necessarily be one of gymnastics, which pre- 
supposes an instructor to see that their form and 
degree are adapted to the constitution and the require- 
ments of the pupil ; but it may and should, for the 
younger classes and for girls, consist of calisthenics, 
which, although they may not develop the muscles to 
any appreciable degree, yet most certainly stimulate 
the circulation and improve the respiration, at the same 



SCHOOL HYGIENE. 29 

time furnishing what is very important, — a pleasant 
recreation. But in some form or other, whether it be 
cahsthenics, gymnastics, or the military drill, a system 
of physical development, properly regulated, should 
form a part of the school curriculum, and in this should 
engage, at regular intervals, the teachers as well as the 
pupils. 

I have thus briefly explained some of the leading 
topics, which enter into a consideration of the subject 
of school hygiene. In presenting them to you I have 
painted no embellished picture of existing facts, nor 
have I portrayed an ideal theory, but one based upon 
the actual experience of parents and physicians. No 
one can avoid recognizing the importance of this vital 
question, nor the responsibilities which it entails upon 
all who are interested in the education of the young, — 
responsibilities which are momentous alike to the child, 
the state, and the nation. For out of the child is 
formed the citizen, and from the citizen is built the 
nation, which, to become wise and powerful, must be 
founded upon the everlasting rock of vigorous health. 

When we ourselves shall pass from this sphere, we 
must leave behind us, as legacies, our children to carry 
forward, we hope more completely and thoroughly than 
we have done, the work of our own lives. Learning 
wisdom, therefore, from our own early mistakes and 
from those of our ancestors, we should, while we live, 
seek to exemplify in the young the present advanced 
knowledge of sanitary laws ; and when we entrust them 
to you teachers through the greater portion of the 
working-day, it is in the expectation that you will not 
only strengthen and improve their minds, but their 



30 SCHOOL HYGIENE. 

bodies also. That this latter desideratum is not more 
frequently reached ; that the health of our youth is not 
more often sustained and improved, is due to no 
fault of yours. For as much as you may desire to 
reform hygienic abuses, you are powerless in most 
instances to effect the needed change. You cannot 
build the schoolhouses ; you cannot plan the ventila- 
tion, heating, nor the drainage ; nor can you, as a rule, 
arrange the hours for study, so as to prevent overwork 
and overstrain. But you can exercise an intelligent 
care over the nervous system ; you have it in your 
power to recognize that certain peculiarities and cer- 
tain defects of constitution exist in some children, 
which must prevent their being judged and trained as 
others, in whom these peculiarities are wanting; you 
can enforce cleanliness both in the schoolhouse and in 
the person of the scholars ; you can notice that this or 
that child is evidently suffering from symptoms which 
may be the precursors of a contagious disease, which 
miij spread through the school ; you can care for your- 
selves ; and finally, and perhaps the most important of 
all, you can inculcate into your teachings the right 
principles of sanitation, and in this way exert in the 
community a powerful influence for good. I know full 
well how easy it is to theorize over the need for 
hygienic laws, and how difficult it is to grasp the prac- 
tical application of them. Hence I am convinced that 
a great necessity exists for a medical inspector of 
schools to help you. Boards of health, no matter how 
excellent they may be (and nowhere in the world are 
they better than those in Boston and Massachusetts, to 
whom all honor for their successful efforts \u every 



SCHOOL HYGIENE. 31 

sanitary work) ; no matter, I repeat, how efficient 
boards of health may be, they cannot, as now consti- 
tuted, properly cope with all the details of school 
hygiene. To be sure, such an officer as I have men- 
tioned would necessitate the expenditure of money ; 
but is it not better that there should be such a judi- 
cious expenditure of money, rather than an injudicious 
expenditure of the health, or, it may be, the lives of 
those to whom we owe such a solemn duty? As such 
an officer never has been appointed (and I doubt if he 
ever will be), and in recognition of the importance of 
hygienic reform in our schools, the new Association 
conies forward to endeavor to point out, not only the 
need for leavening the loaf, but to offer the proper 
advice for its accomplishment. 

This is in part its mission, and this its work, — a 
work which it expects to push into all sections of the 
State, — a mission which it intends shall teach that 
hygienic abuses exist much more frequently than per- 
haps we ourselves have imagined; that individuals 
and communities cannot with impunity ignore the fact 
that they are in a great degree responsible for their 
own health; and finally that, just in proportion as this 
fact is lost sight of, just as surely as any of the sanitary 
laws are disobeyed, just so surely will disease continue 
to prevail, to the detriment not only of ourselves but 
of our descendants, to whom we are morally responsi- 
ble for our own neglect of hygienic precautions. In 
this field of labor we cannot and will not pause, until, 
as clearly as possible, we are enabled to cry, " Sanitas 
sanitatum, omnis est sanitas." 



VENTILATION AND WARMING. 

v/ 
By F. W. draper, M.D., 

Assistant Professor op Legal Medicine in Harvard University. 



I CONSIDER myself peculiarly fortunate, ladies and 
gentlemen, in having the privilege of introducing this 
course of sanitary lectures before the teachers of Boston. 
It is a rare opportunity that is offered, to speak to an 
intelligent company of men and women about matters 
of school hygiene. Your attendance here, in such 
goodly numbers, on this day of rest and recreation from 
your exacting duties, testifies emphatically that you 
appreciate the importance of the topic to which your 
attention is invited. And your appreciation is not 
misplaced ; for to what class of people in the world is the 
subject of more vital concern than to you whom I 
address? You represent many homes where the prac- 
tical application of the laws of health are never out of 
place. You are members of a profession whose daily 
work, under prevailing methods, exposes you to enor- 
mous drafts upon physical and mental vigor. In the 
daily routine of school duties, the condition of the 
school-room itself is not the least important factor in 
explanation of the tired nerves, the headaches, the 
physical and mental exhaustion, which are too often 
accepted as the teacher's cross, to be borne because it 
is thought to be inevitable. 



34 VENTILATION AND WARMING. 

You represent, too, sixty thousand school-children, 
the pupils of our public schools, the symmetrical train- 
ing of whose minds and bodies is intrusted to your in- 
telligent oversight and direction. It depends largely, 
as I hardly need to tell you, upon the light, the air, the 
warmth, the furniture and appointments of the school- 
room, almost more than upon the study-tasks required, 
whether these children remain at their desks to do their 
work efficiently and successfully, or suffer detriment by 
their attendance at school. 

To aid in elucidating the laws of hygiene which 
modern sanitary science has formulated in their special 
application to the school-room, for the health of teachers 
and of scholars alike, is, as I understand it, the purpose 
of these lectures , and it is my privilege this morning to 
speak of one important branch of the general theme, 
namely, of ventilation. 

And I venture to remark, at the outset, that there is 
no to^ic connected with sanitary science which has re- 
ceived so much attention as this, none about which so 
much has been written in books or spoken in lectures, 
which has given rise to so much varied discussion, fan- 
ciful theorizing, impracticable invention, as well as 
scientific investigation. It has taxed the ingenuity of 
the architect, and has tested the speculative talent of 
the sanitarian. It has excited warm dispute between 
rival originators of so-called systems of ventilation, and 
has put into the market a multitude of patent devices 
designed to solve the question of the best way to supply 
pure air to enclosed spaces. 

All this is good proof of the importance of the subject 
in its bearings on public health; and although it can 



VENTILATION AND WARMING. 35 

scarcely be said that there is yet that unanimity of 
opinion among sanitarians and architects and builders 
that would seem to be desirable with reference to the 
methods by which the wished-for end can be gained, 
there is nevertheless entire harmony concerning the end 
itself, — the vital consequence of pure air as a fun- 
damental condition of healthy living. " In modern 
hygiene," says Play fair, " nothing is more conclusively 
established than the fact that vitiated atmospheres are 
the most fruitful of all sources of disease." 

This feeling about the theoretical importance of hav- 
ing pure air to breath is shared to a large degree by 
intelligent people who are not supposed to make such 
matters a special study. Scarcely anybody will demur 
when you tell him how necessary it is to health to have 
clean, unpolluted air in his house. He will say that 
ventilation is very desirable as a matter of course ; but 
if you go with him to his house, you will generally find 
that he by implication makes reference to his neighbor's 
premises, not to his own. In the great majority of 
modern dwelling-houses and public buildings, it would 
seem that particular pains had been taken to defeat 
ventilation, not to promote it. With all the enlighten- 
ment and instruction and investigation of recent times, 
our people are lamentably lacking in the means by 
which the subject should literally be " brought home " 
to them. The theme has been ventilated, but that is 
about all. 

Now when we use the word "ventilation," what do 
we mean in exact terms? Primarily, we mean a renewal 
of the air of inclosed places, a substitution of pure air 
for foul air, a restoration of the air of inhabited rooms 



36 VENTILATION AND WAEMING. 

to its normal state of purity. In this view, the problem 
of ventilation seems a simple one. Undoubtedly it is 
easy to renew the air of our rooms by opening the 
doors and windows. But there is immediately inter- 
posed another element in the case, namely, that of 
warmth. The two subjects of ventilation and warming 
belong together ; they cannot be dissociated. We may 
ventilate our rooms, but they will be rendered cold in 
the act; we may warm our rooms and vitiate the air 
in the process of shutting out the cold and keeping in 
the heat. The two' matters must be harmonized, and 
therein lies the difficulty. 

Fresh, pure air is the great natural disinfectant and 
antiseptic, and is not to be compared for a moment with 
any of artificial contrivance. There is plenty of it in the 
world, and every human being is entitled to his full 
allowance ; yet, disguise the fact as we may, there is no 
getting over the unwelcome truth that to provide it in 
abundance in our climate is expensive, since, during 
seven months of the year, it must be artificially warmed. 
To take in air at the average winter temperature of 
28°, raise it to 68°, and discharge it again, if only as 
often as once in an hour, is a process which cannot be 
accomplished without paying roundly for it ; yet upon 
no other condition can we reasonably expect the desired 
results. The better way is freely to admit that it is 
expensive, but worth all it costs in money and trouble. 

In our study this morning of the subject, I propose 
to ask your attention first to the constitution of pure 
air ; then, to show in what directions vitiated air differs 
from pure air, and in what manner pure air becomes 
spoiled; and, finally, to indicate the methods which 



VENTILATION AND WARMING. 37 

modern science approves for keeping the air of in- 
habited rooms in a fit state for respiration. 

As a point of departure for our consideration of 
the problem of ventilation, let us get a clear idea, in 
the first place, of what we mean by j)ure air. Let the 
chemist aid us to an answer to our question. He tells 
us that the atmosphere consists of several gases and 
vapors in a state of mechanical admixture, not of 
chemical union. These constituents may be expressed 
as follows : — 

Oxygen I Chief elements. 

Is itrogen ) 

Water "] 
Ammonia 



Carbonic acid 
Ozone 

Nitrous acid 
Nitric acid 



>• Elements present in minute quantities. 



Oxygen gas, as you know, is the most important of 
these elements, for most of the functions discharged by 
the air depend on it alone. The respiration of the 
entire animal kingdom and the ordinary processes of 
combustion are solely maintained through its agency, and 
many of the great changes continuously passing over 
the face of nature are the result of the action of this 
potent agent. For a long time it was supposed that 
the relative proportions of oxygen and nitrogen in the 
atmosphere were the same under all circumstances; but 
recent and more accurate investigations have shown 
that tlie relation is not constant. The variations are 
within very small limits, however, and are produced 
almost wholly by the processes of the combustion of 



38 VENTILATION AND WARMING. 

fuel and the respiration of animals. The researches of 
the best chemists have demonstrated that oxygen com- 
prises, by volume, about one-fifth of the air in its 
normal state, or, to be accurate, 2,096 volumes in 
10,000. 

The properties of nitrogen have very little in them 
to interest the sanitary student. We know that this 
gas is without color, taste, and odor ; that it is a little 
lighter than atmospheric air; that it cannot support 
combustion or respiration, and that, by diluting the 
atmospheric oxygen, it renders the latter less stimulat- 
ing. It comprises seventy-nine per cent of the volume 
of the air. 

That water is present in the air is demonstrable by 
the familiar fact of its deposition on an ice-cold vessel. 

The importance of carbonic acid as a constituent of 
the air has been recognized very fully ever since in- 
vestigations into the relation of the atmosphere to health 
began to be made. Very much of the interest attaching 
to the subject is due to the original researches of two 
French chemists, father and son, named de Saussure. 
These patient experimenters found that the air con- 
tained more carbonic acid in summer than in winter, 
during the night than during the day, over land than 
above water, during seasons of drought than in wet sea- 
sons or after a rain, in towns than in fields, on the 
mountains than on the plains. This last difference they 
referred to the rains and the moisture of the ground, as 
well as to vegetation, which diminishes the carbonic acid 
and increases the oxygen. The average of the results 
determined by these observers is that normal air con- 
tains 4.5 parts of carbonic acid in 10,000 of air, and we 



VENTILATION AND WARMING. 39 

may say that 4 parts in 10,000 is a safe standard mean 
of purity, and that if this is increased, we shall presently 
have sensible vitiation of the air in any given case. 

The other constituents of normal air — ammonia, 
ozone, nitrous and nitric acids — are either so negative in 
their significance or so little understood that their study 
need not detain us. 

Thus far we have studied, somewhat cursorily indeed, 
the composition of unadulterated air, such as is found at 
a distance from any source of contamination. But it is 
manifest that the sanitary student is concerned less 
with the normal constitution of the atmosphere than 
with those conditions wherein it is vitiated and ren- 
dered unwholesome. If the air which we breathe were 
constantly and uniformly the pure air of the Scottish 
highlands or of mid-ocean, many of the problems of sani- 
tary science would be greatly simplified. The question 
of practical impoi'tance is constantly recurring, — how 
shall we maintain the purity of this agent so that its 
respiration shall do no harm ? It becomes necessary, 
therefore, to inquire in what way and to what degree 
the air is contaminated and made harmful, how and how 
much its natural ingredients are altered in their consti- 
tution and in their relation to each other, and what 
efiects this alteration may have on health. 

And first, with reference to oxygen. It is clear that 
the diminution of the relative amount of this life-sus- 
taining agent is the only way in which a change in its 
normal relation can prove harmful. This is manifest 
both to reason and by experience. Angus Smith 
has given us many facts showing conclusively the dimi- 
nution of oxygen in places where numbers of persons 



40 VENTILATION AND WAEMING. 

have assembled, and abundantly proving that attention 
to small differences in the proportion of this gas is of 
great importance. He found that the air of the open 
heaths of Scotland contained, by volume, 20.999 per cent 
of oxygen ; in a sitting-room which seemed moderately 
close the percentage had diminished to 20.89 ; in the 
pit of a theatre, at half-past eleven o'clock in the even- 
ing, it was 20.74 ; in the air of a mine it was 18.27; and 
in a place so oppresively close that it was difficult to 
remain in it many minutes, it was 17.20. Upon these 
small differences, Smith remarks, " Some people will 
probably inquire why we should give so much attention 
to such minute variations, thinking that they can in no 
way affect us. A little more or less oxygen might not 
affect us , but supposing its place occupied by hurtful 
matter, we must look on the change as not too small to 
notice." 

The degree of relative humidity which air should 
possess for wholesome breathing has been the subject of 
much inquiry. The questions of what is too much and 
what is too little in the matter of moisture open for discus- 
sion the whole subject of climatology. We find under 
what may be deemed natural conditions, unmodified by 
artificial agencies, such great differences in the relative 
amount of aqueous vapor that it is very difficult to lay 
down exact propositions concerning the healthf ulness of 
a very dry or a very moist atmosphere. Who can de- 
cide that the dry air of Minnesota is more salubrious than 
the moist air of Newport? With our present knowl- 
edge there is no reason for inferring that either is 
wanting in a degree of humidity favorable to health and 
long life. There are times, it is true, as in the " dog- 



VENTILATION AND WARMING. 41 

days " of our northern summer, and places like the low- 
lying swamps of the southern coast, in which a warm 
atmosphere, saturated with moisture, is oppressive ; but 
we cannot positively declare that it is, in itself, to be con- 
sidered unwholesome. We must not forget, moreover, 
man's adaptability to changing conditions of atmospheric 
humidity ; he is able to bear and to enjoy considerable 
alternations of both temperature and moisture. Animal 
heat is maintained at about 98° Fahr., whether the ther- 
mometer registers the temperature of the air at 30° 
below zero, or at 90° above. So it is also true that man, 
being himself a reservoir of water, three-fourths of his 
body being made up of that element, becomes capable 
of adapting the air about him to his necessities with 
reference to moisture, by supplying to it through his 
skin and lungs the watery vapor needed to maintain 
the proper supply to an atmosphere temporarily made 
too dry by natural causes. The tolerance by man of air 
possessing the extremes of humidity is shown on the one 
hand by the good health of sailors in tropical seas, 
breathing an air nearly or fully saturated with moisture, 
and on the other hand by the robust vigor of Arctic ex- 
plorers in an air at the other extreme of dryness. These 
observations have an obvious bearing on the popular 
method of supplying moisture to the air of heated rooms 
by the evaporation of water held in tanks or other 
vessels in connection with the heating apparatus. 

Ammonia in the air is one measure of the sewage of 
the atmosphere ; it is the result and gauge of decompo- 
sition. By itself it is not an impurity. It is not found 
free, but is combined in town-air with chlorine or sul- 
phuric acid; in country air it is probably in union with 



42 VENTILATION AND WAKMING. 

carbonic acid. Wherever the air is foulest, the ammonia 
will be found most abundant. 

But of all the atmospheric ingredients, the alteration 
of whose normal proportion has been deemed of special 
significance, carbonic acid has claimed and received the 
most attention. Chemistry has done much toward as- 
signing to this agent its true place. Formerly it was 
thought to be the one essential element to be studied in 
connection with vitiated air, — the poisonous product of 
respiration, of which oxygen was the antidote. Now, 
however, while we are far from an exhaustive knowl- 
edge of atmospheric impurities, carbonic acid is looked 
upon as harmful because it obstructs respiration , be- 
cause, through its accumulation, the oxygen is dimin- 
ished, and so the air becomes adulterated and its life-sus- 
taining properties are impaired. According to Bernard, 
when an animal dies from the inhalation of carbonic 
acid its death is owing to the mere want of respirable 
air ; the action of this gas, therefore, is negative or suf- 
focative, not directly poisonous. 

But however innoxious we may consider carbonic 
acid to be in itself, it is not without great interest as an 
ingredient of foul air ; for it affords us a constant and 
reliable test of atmospheric impurity. It is the compo- 
nent whose relative amount is most easily and accurately 
measured ; and as the other and more harmful parts of 
a vitiated air are known to bear a tolerably constant 
relation to this, we come to look upon the chemical 
determination of its presence and amount as a trust- 
worthy guide concerning all the rest. 

The amount of carbonic acid which the atmosphere 
may hold before it becomes unfit for respiration is, 



VENTILATION AND WAKMING. 43 

therefore, a matter of the first importance to ascertain. 
The proportion of the gas in* pure air is, as we have seen, 
an average of 4 volumes in 10,000. Parkes states that 
tlie ventilation of a room is imperfect when it fails to 
introduce fresh air in sufficient quantity to remove all 
sensible impurity, so that a* person coming from the ex- 
ternal air shall not perceive a trace of odor or any dif- 
ference between the room and the outside atmosphere 
in point of freshness. By repeated experiment he found 
that the organic products of respiration began to be 
manifest when the carbonic acid of the air of an in- 
habited room reached the proportion of six-hundredths 
per cent ; in other words, when, by respiration, the 
relative amount of carbonic acid in the air exceeded by 
2 volumes in 10,000 its proportion in pure air. 

The amount of carbonic acid which badly-fouled air 
may contain above the limits mentioned are, of course, 
exceedingly variable. A great mass of observations 
has been accumulated by chemists. It is needless to 
quote many of these results, and I therefore content 
myself with a mention of some of the more remarkable 
of them, as follows : — 



44 



VENTILATION AND WARMING. 







Volumes of 




Authority. 


carbonic acid in 
10,000 vols, of air. 




Parkes. 
De Chaumont. 


4.0 


Barracks at Anglesey .... 


19.7 


Portsmouth Military Hospital . . 


a 


20.5 


Aldershot prison 


a 


34.8 


Boys' school 


Roscoe, 


31.0 


Girls' school (70 scholars) . . . 


Pettenkofer. 


72.3 


London theatre 


Angus Smith. 


32.0 


Metropolitan Railway (London) 


(' 


38.8 


Cabin of a canal-boat .... 


Cameron 


95.0 


Boston school-house ^ . . . . 


W. R. Nichols. 


30.0 




<( 


25.6 


" " 


a 


20.7 



The sources of this increase in the carbonic acid of 
the air are various. A certain portion comes from the 
vital processes of the animal creation. Combustion is 
responsible for a considerable part. Angus Smith has 
estimated that in Manchester fifteen thousand tons of 
carbonic acid gas were thrown daily into the atmosphere 
as the result of the combustion of coal in that busy city. 
Many manufactories emit the gas as a product, not only 
of their fires, but also of the processes upon which they 
are engaged. Illuminating gas, also, gives out a large 
amount as a result of its combustion. 

We have now studied the various natural constituents 
of the air in their relation to life and health, the relation 
of these constituents in pure air, and their altered rela- 
tion in vitiated air. We pass now to examine some of 

1 These observations on the air of Boston school-rooms were made in 1875 by 
Prof. William Ripley Nichols, in the course of an investigation by the writer and 
himself, whose results are recorded in the Report of the Boston City Board of 
Health for 1875. 



VENTILATION AND WARMING. 45 

the adventitious matters which are found commonly in 
the atmosphere. 

A vast number of substances, vapors, gases, or solid 
particles continually enter the air. Many of these can 
be detected neither by smell nor taste, and are inhaled 
without any knowledge of the fact by those who breathe 
them. Others are perceived at first, but in a short time 
the nerves lose their delicacy, so that, in many cases,.no 
warning is given by the senses of these atmospheric im- 
purities. As if to compensate for this, a wonderful 
series of processes goes on in the atmosphere or on 
the earth, tending to keep the air in a state of purity. 
Gases diffuse and are carried away by winds, and thus 
become innocuous , or they are washed down by rain. 
Solid substances, lifted into the air by the wind or by 
the ascensional force of evaporation, fall by their own 
weight ; or, if organic, are oxidized into simple products ; 
or they dry, and break up into impalpable particles, 
which are washed down in the rain. Diffusion, dilution 
by the winds, oxidation, and the fall of rain are thus 
tlie great natural purifiers ; and, in addition, there is the 
wonderful laboratory of the vegetable world, which keeps 
the carbonic acid of the air within limits. If it were 
not for these agencies, the air would soon become too 
impure for the animal kingdom ; as it is, it is wonderful 
how soon the immense impurity which daily passes into 
the atmosphere is removed, except when the perverse 
ingenuity of man opposes some obstacle, or makes too 
great a demand upon the purifying powers of nature. 

We have not the time to study with much nicety the 
composition and essential characters of the great num- 
ber of suspended matters which diligent search by 



46 VENTILATION AND WARMING. 

chemists and microscopists has discovered in the air. 
The subject is as fascinating as it is vast. I can touch 
npon its more salient features only. 

And, first, of the organic matter which is given off by 
the skin and lungs of living animals. The amount of 
this material in the atmosphere has never been precisely 
determined, nor is it possible at present to estimate it 
correctly. It must be in part suspended matter, which 
is made up of small particles detached from the skin and 
mouth, and partly of an organic vapor given off from 
the lungs. It has a fetid and persistent smell, which is 
retained in a room for so long a time, even when there 
is free ventilation, as to show that it is oxidized slowly. 
Is is probably in combination with water, for the most 
hygroscopic substances absorb it freely. The air of an 
unventilated bed-room in the morning displays its typi- 
cal characters. It is probably not a gas, but is molecu- 
lar, and floats in clouds through the air. In a room the 
air of which is at the beginning perfectly pure, but 
which becomes fouled by respiration, the smell of organic 
matter is generally perceptible when the carbonic acid 
reaches the degree of seven parts in ten thousand of the 
air, and is very strong when the proportion rises to ten. 

Turning now to the study of the dust which is always 
suspended in the atmosphere, and which is demonstrable 
by means of the sunbeam admitted to a darkened room 
through an aperture in the shutter, we come upon an 
almost inexhaustible subject. The laborers in this field 
of inquiry have been many, and their patient researches 
have elucidated many of the problems incidental to ven- 
tilation. I can scarcely do more than to indicate some 
of the results which have been reached. And, first, let 



VENTILATION AND WARMING. 47 

me speak of the living organisms in the air. When the 
atmosphere is drawn through previously heated glass 
tubes surrounded by a freezing mixture, these organisms 
are deposited in great numbers. Angus Smith has esti- 
mated that 529,000 of theai may be found in a cubic 
foot of city air. Tliey are in great variety, one ob- 
server having determined two hundred forms. Spores 
of fungi, pollen of flowers, living animalcules, and parts 
of insects are found ; and, with them, mineral substances, 
such as particles of sand. The microscope finds, too, in 
atmospheric dust, bits of cotton, woollen and linen fibre, 
and of human and animal hair. In some cases, articles 
of furniture supply a portion of the dust; the flock 
wall-papers tinted green or otherwise by arsenical color- 
ing matters, give off particles of arsenical dust, and, in 
cases of persons particularly susceptible, may produce 
grave symptoms of chronic arsenical poisoning. 

The ordinary conditions of the unrenewed air of a 
school-room are quite enough to astonish us, if we stop 
a moment to think of them. For there are not only the 
inevitably vitiating efi"ects produced by respiration and 
the constant activity of the skin in persons who are 
healthy and cleanly, but the additional exhalations pro- 
ceeding from unclean bodies, from ill-ordered mouths, 
from decaying teeth, from dirty clothing, too frequently 
accompanying the city school-boy or school-girl to the 
crowded room which is the scene of their daily tasks. 

The effects of breathing and re-breathing an atmos- 
phere thus charged with harmful matters are not far to 
seek. Every one of us must have experienced at some 
time or other the noxious influence of an air thus viti- 
ated. We all remember the unpleasant closeness, the 



48 VENTILATION AND WAEMING. 

headache, languor, and sometimes nausea, resulting. 
We are told of the poisonous effects, in the form of 
fever, coming from larger doses of this irrespirable air ; 
and we have heard of the sudden and rapid manner in 
M^hich, in still larger amount, it kills those exposed to 
it, oft-quoted examples of v^^hich are to be found in the 
story of the Calcutta " black-hole " prisoners, the Aus- 
terlitz prisoners, and the ill-fated passengers of the 
steamer Londonderry. 

There is another imj^ortant thought in this connection. 
Besides these direct effects of inhaling a foul atmos- 
phere, an indirect and not less significant consequence 
is recognized. Disease may be powerless in its assaults 
on the perfectly healthy human system, while it may 
find lodgement in a body which bad air, by lowering the 
tone and depressing the vital vigor, has made an easy 
victim of epidemic influence. Many a case of sickness 
proves fatal on account of an unperceived prostration of 
the sufferer's strength by continuous exposure to an 
atmos2:)here impure from exhalations from the body, and 
many children yield easily to contagious disease through 
the devitalizing effects of breathing an unwholesome 
school-room air. 

But in adducing evidence to show on the one hand 
the baneful effects of a vitiated atmosphere upon health 
and life, the beneficial influence, on the other, resulting 
from improved methods of ventilation, it is not so agree- 
able to recite traditional examples of wholesale poison- 
ing as to remember, in contrast with such cases, the 
wholesome power of ventilation to save life. During 
the 25 years following 1758, when the Rotundo 
Hospital was founded in Dublin, for the care of new- 



VENTILATION AND WARMING. 49 

born chiklreu and their mothers, one in- six of the 
infants died. The hospital, which hitherto had been 
unventihited, was now altered so as to allow a free 
supply of air, and for 25 years following this change 
the mortality was 17 times less than during the former 
period. 

An important preliminary question, before we enter 
upon the practical details of ventilation, is what amount 
of air-space should be allowed in a room like a school- 
room, for each of its occupants? This should be suffi- 
cient to permit the passage of the requisite quantity of 
air into, through, and out of the room, without creating 
perceptible air-currents in the form of draughts. If 
the cubic space for each person in the room is small, 
renewal of the air will necessarily have to be much 
more frequent than when it is large. Thus, with a 
space of 100 cubic feet, the contained air must be 
renewed thirty times per hour in order that the stand- 
ard amount be supplied ; whereas, with one of 1000 
cubic feet, only three renewals would be required. 
What, then, is the minimum of cubic space through 
which the standard amount of fresh air can be passed 
without perceptible movement? Prof. Pettenkofer has 
answered this question by means of experiments ; and 
has found that with artificial ventilation with the best 
mechanical contrivances, the air in a chamber of 424 
cubic feet may be renewed six times hourly without 
any appreciable air-currents. No doubt, therefore, such 
an allowance of space would be adequate if proper 
means of artificial ventilation are applied, and the air is 
warmed. But with natural ventilation, it would be 
insufficient. Dr. Parkes maintains that air changed 



50 VENTILATION AND WAKMING. 

four, or ev6n three, times per hour is all that can be 
borne, and this would require an initial air-space of 
from 750 to 1000 cubic feet. This is far above the 
usual allowance. In the crowded rooms of the labor- 
ing classes, and in many school-rooms, the cubic space 
for each person would much more often be found to be 
200 or 250 cubic feet than the larger allowance. The 
expense of the larger rooms would obviously be an 
obstacle to such an ideal standard ; but the question 
with us is not what is likely to be done, but what 
ought to be done. 

Having thus ascertained how much air-space is con- 
sidered by the best authorities requisite for good venti- 
lation, we are next to inquire what are the means by 
which we secure a renewal of the air of rooms. How 
is the air set in motion? In the first place, air may be 
set in motion by the forces continually acting in 
nature ; these produce the so-called " natural " ventila- 
tion. In the second place, we have the forces put into 
operation by human ingenuity, constituting what is 
described as " artificial " ventilation. It is obvious 
that, in practice, there is, in greater or less degree, a 
constant combination of both classes of forces, but the 
classification is useful for purposes of description. 

Now, there are mainly three factors which act in 
natural ventilation ; namely, diffusion, the wind, and, 
in inclosed spaces, the difference in weight of masses of 
air of unequal temperature. The amount of ventila- 
tion produced by diffusion is shown to be entirely 
inadequate. It depends, for its action, on the property 
which' all gases have of diffusing in proportion to their 
density. This diffusion goes on between the inner and 



VENTILATION AND WARMING. 51 

tlie outer air through chinks and crevices left by im- 
perfect carpentry in the walls of dwellings. Indeed, it 
has been demonstrated by Pettenkofer that it goes on 
through the solid masonry of the walls themselves, 
which, though apparently solid, are yet porous enough 
to permit the constant transpiration of the air. This 
transpiration is favored by contrasts of temperature. 
Pettenkofer found that an ordinary room in his house, 
whose walls were of brick, had its entire atmospheric 
contents changed once an hour, when the difference 
between the outside and the inside temperature was 
34° Fahr., the doors and windows being shut mean- 
while. This power of transpiration differs, of course, 
according to the material of which the walls are built, 
it having been found that the free use of mortar pro- 
motes the porosity of house-walls. 

Secondly, we have the action of the wind as a factor 
in natural ventilation. The wind acts to effect this 
result in various ways. If it can pass freely through a 
room whose doors and windows are open, acting by 
perflation, as it is called, the result is really beyond any- 
thing to be obtained in any other way. Air moving 
at the rate of only two miles an hour (a rate almost 
imperceptible out of doors), and allowed to pass freely 
through a space 20 feet wide, will change the air of the 
space 528 times in an hour. Perflation is by far the 
readiest means which can be adopted for removing 
speedily and effectually aerial impurities from a room ; 
but it cannot always be depended on because of the 
uncertainty of the rate of movement, for if the air be 
still, there can be little or no perflation ; and, on the 
other hand, if the rapidity of movement is great, it be- 



62 VENTILATION AND WARMING. 

comes insupportable. A current of cold air moving at 
the rate of five or six feet per second becomes unbear- 
able. In spite of this objection, however, cross-ventila- 
tion ought always to be provided for by means of 
windows whenever it is practicable, especially in large 
rooms like school-rooms ; and in all intermissions in the 
school exercises, the windows should be widely opened 
for the thorough and rapid renewal of the contained 
air. 

Again, the aspirating action of the wind produces 
up-currents through chimneys and air-shafts, by creating 
a partial vacuum which is constantly being filled by the 
column of air beneath. 

The mechanical arrangements which have been pro- 
posed or adopted to facilitate the action of these various 
natural forces are very numerous. To use the perflating 
force of the wind, opposite windows should be made, 
whose upper sash, reaching nearly to the ceiling, can be 
lowered as freely as the lower sash can be raised. To 
obviate the unpleasantness of draughts, some such 
plans as the following have been suggested : — The 
window-sash may be so made that the top slopes in- 
ward, to direct the entering current of air toward the 
ceiling; the same end is gained hy a wooden screen 
placed within and against the upper part of the upper 
sash, and sloping upward. Another plan is to place a 
glass louvre in the middle section of the upper sash. 
Or some of the panes may be doubled, the outer pane 
having an open space at its lower edge, and the inner 
pane having a similar opening at its upper edge ; the 
entering air thus passing between the two. A fine 
wire screen is sometimes adjusted at the top of the 



VENTILATION AND WARMING. 53 

window, to unfold when the sash is lowered, and to 
break and diffuse the entering current of air. The 
aspirating power of the wind is best utilized by placing 
some form of cowl or louvre on the chimney or air- 
shaft. Sometimes these are made to rotate so as to 
keep the opening of the cowl away from the wind ; 
and sometimes, probably most often in this country, 
the so-called " ventilator " at the top of the air-shaft is 
fixed and so constructed with angles and bevels that it 
combines the cowl with the louvre. 

The most scientific, as they are also the most success- 
ful, plans for ventilation do not rely on any of these 
devices for using natural ventilation by means of the 
action of the winds. They omit any positive depend- 
ence on all kinds of apparatus or contrivance operated 
by passing currents of air, — all kinds of turn-caps, 
louvres, cowls and the like, — except in so far as they 
may be made subsidiary to other measures. Such con- 
trivances are not to be trusted, for the reason that they 
are as uncertain as the wind itself; so that frequently, 
and sometimes for long intervals of calm weather, when 
ventilation is most desired, they are good for nothing. 
During brisk and active winds, any and all varieties of 
them will produce a considerable fluctuating upward 
current; at such times, however, the natural ingress 
and escape of fresh air unassisted is the most ready, so 
that the necessity for artificial aid is the least urgent. 
In the stagnant atmosphere often prevailing week after 
week, at certain seasons of our climate, the need of cer- 
tainty of change in the air of school-rooms is most 
imperative. The effect, at these times, of any or all of 
the various patented contrivances is mainly to impede, 



54 VENTILATION AND WARMING. 

instead of assisting the internal air to escape, by plac- 
ing an obstruction at the outlet of the ventiduct. 

There is another important and very obvious reason 
why we cannot rely on natural ventilation. It must 
not be forgotten that, as I have said, during seven 
months of the year in our climate the direct admission 
of the external air into school-rooms cannot or will not 
be borne. Our schoolhouses are built with reference 
to winter and warmth, and ventilation must be pro- 
vided for by special arrangements which must include 
some means for warming the air as well as changing it. 
This compels the application of what is called artificial 
ventilation. It aims to solve the combined problem of 
ventilation and warming. 

In all our attempts to ventilate rooms, and at the 
the same time to preserve a uniform and wholesome 
temperature in them, we must bear in mind that we are 
living at the bottom of an ocean of air, which presses 
equally in every direction, and whose weight and 
degree of pressure, and their laws, are accurately 
known. Any portion of this air on being heated ex- 
pands in volume, and becomes specifically lighter than 
the neighboring portions, which have, therefore, a 
greater tendency to fall toward the earth, and thus to 
push the lighter portion upward. Heated air, thus 
expanded, ascends, not however from any such power 
in itself, but solely because it is pushed upward by the 
fall of the denser, colder, and therefore heavier, air tak- 
ing its place. These truths are frequently overlooked 
by contrivers of ventilating schemes ; they know the 
fact that hot air rises, and they think, therefore, that 
nothing more is necessary than to make an aperture at 



VENTILATION AND WARMING. 65 

the top of the room, and through this the foul heated 
air will naturally go out. But it will not do so unless 
an exactly equivalent volume of colder air finds 
entrance at the same time, to push it out. If no 
properly devised plan of ventilation is applied by which 
an ample supply of fresh warmed air is provided, the 
principle of spontaneous, natural ventilation will come 
into operation to a certain, but entirely inadequate 
extent, and cold air will in some way gain admission ; 
for it must be remembered that the fires, and even 
human beings (who likewise produce heat by consump- 
tion of oxygen), keep the air in constant motion by 
varying the temperature of its currents ; they convert 
the house or room into a modified kind of vacuum, 
the draughts of which are inward. Thus the tendency 
of the outer air must be to enter at all possible apertures ; 
if legitimate and sufficient ones are not provided, it will 
come through all others that are to be found, such as ill- 
fitting windows and doors, crannies in the base-boards 
and floors, even through the more or less porous walls 
themselves. There is danger, indeed, that the supply 
of cooler air may be drawn from places not desirable as 
air-supplies, — from sinks, water-closets, drains, cess- 
pools, cellars, and the ground. 

Now, a purely ideal plan of artificial ventilation would 
require that all these adventitious and hap-hazard inlets 
for new air should be closed and give place to proper 
special ducts and openings. It would require that good 
workmanship should exclude cold and economize heat. 
It would make the windows, not only tight at their 
joints, but, by duplicating the sashes, or by duplicating 
the panes in single sashes, it would make them bad 



66 VENTILATION AND WAKMING. 

conductors of heat without interfering with their legiti- 
mate office for the transmission of light. It would make 
the walls double in order that they also might aid in the 
saving of heat. Practically, of course, this condition of 
things is not generally attained, and theoretical prin- 
ciples of ventilation do not have an opportunity for 
their complete application. As Dr. Reid well remarks, 
in any scientific plan, the apartment to be ventilated is 
to be deemed and treated as a j)iece of philosophical 
apparatus, the results of the operations of which are not 
to be interfered with by any fortuitous influences. 
Desirable as this may be from a purely ideal standpoint, 
we are concerned rather with the question whether sani- 
tarians and architects have united upon any principles 
which are available for the practical solution of the 
problem of ventilation. 

It must be evident from what I have said that for the 
effective working of any scheme of artificial ventilation 
the following essentials are imperatively requisite : — 
I. An inlet for fresh air. 
II. An outlet for vitiated air. 

III. Proper means for promoting the motion of the 
air-currents in the right direction. 

If these three provisions are made for any enclosed 
space, — sleeping-room, dwelling-room, school-room, or 
hall, — artificial ventilation is practicable and effectual ; 
if either of them is omitted from the plan, the working of 
the rest will be a delusion and a disappointment. 

And first, of the inlet. It seems superfluous that I 
should insist on the necessity of obtaining the supply of 
fresh air from pure, external sources ; yet this necessity 
is so often overlooked that it should be emphasized. 



VENTILATION AND WARMING. 67 

Air should never be taken from the cellar or basement 
of a building, nor should it have its passage through 
accidental crevices, or be drawn from any spot likely to 
become polluted. The size of this fresh-air opening is 
a matter of importance. Whenever it is provided at all 
in our buildings it is almost always too small. 

The artificial warming of the in-coming fresh air should 
be considered at this point. I think that we may lay 
it down as a general rule that air should be tempered to 
a proper degree before it enters the room where it is to 
be used, and that any heating apparatus should be re- 
garded as a way-station in the progress of the new air 
to the place of its destination. Two chief varieties of 
heating appliance are in vogue for carrying out the plan 
of warming the air, — the hot-air furnace placed in the 
cellar of the building, and the high-pressure or low-pres- 
sure steam apparatus. Of all methods, the well-known 
steam-radiator, properly appointed, is the cleanest, the 
safest, and, on the whole, the most agreeable and satis- 
factory. The hot-air furnace, as it is usually con- 
structed, is not without danger to health on account of 
the readiness with which the air becomes superheated, 
and because of the readiness, too, with which the air 
may become charged with noxious gases. Undoubtedly, 
therefore, the best and safest mode of heating now prac- 
tised is that in which the air, drawn from without the 
building, is passed through coils of pipes filled either 
with steam or hot water. It is universally admitted 
that the true rule about heating the air is never to have 
its temperature raised above that degree which results 
from the contact and radiation of metallic pipes filled 
with hot water or steam. A peculiarly unwholesome 



68 VENTILATION AND WARMING. 

change appears to be wrought in the atmosphere by- 
raising its temperature to any point higher than the 
boiiing-point of water. 

It is needless to remark that American people suf- 
fer from the superheating of their rooms in winter, a 
fact so obvious that it will suffice simply to state it. 
Custom and common consent have established 68° Fahr. 
as the point below or above which there should be the 
slightest possible range. How very much more often 
it is exceeded than otherwise, the observations of every 
one of us can attest. 

Every school-room should be provided with two or 
three good thermometers, distributed in different parts 
of the room. This is the onlj^ guide which can be 
trusted for determining the degree of heat. Personal 
sensations are an unsafe test. 

Let me insist again, at the risk of being tedious, that 
whether one form of heating or another is used, whether 
it be the furnace in the cellar or the steam-coil in the 
school-room, each should have a copious supply of fresh, 
pure, outside air admitted to it, — the furnace by its 
"cold-air box," so-called; the steam-heater, by an opening 
through the immediately adjacent wall of the building. 

Now, our supply of new air, properly warmed, being 
ready for distribution, how shall it be delivered to the 
rooms where it is needed ? You know that the usual way 
with furnace-heat is by a single register or two registers 
opening from the hot-air chamber around the furnace, 
and placed in or very near the floor. Whether that is 
the best way is still an open question among sanitary en- 
gineers. Some say that the fresh air, whether it be warm 
or cold, should be admitted near the ceiling, through 



VENTILATION AND WARMING. 69 

the cornice ; others declare that this method does not 
supply the fresh air where it is required for respiration 
by the occupants of the room, and that it simply dilutes 
the layer of foul warm air, which by its lightness occu- 
pies the upper part of the room. Nevertheless very ex- 
cellent results have been obtained by this apparent 
reversal of the natural current, and rooms whose fresh- 
air supply is delivered near the ceiling by many inlets 
appear to present a satisfactory condition, when proper 
provision for removing the wasted air is made. 

Having thus studied the inlet supplying the pure 
external atmosphere properly heated, we are now to 
consider the equally important outlets for vitiated air. 
You are familiar with the usual school-room arrange- 
ment. At one side or in one corner of the room is a 
shaft, usually of wood, in which, either at the top or 
the bottom of the room, and frequently at both top and 
bottom, there is a slide or a register under the teacher's 
control. This foul-air shaft leads to the top of the build- 
ing to a reservoir or cupola Avhere all the shafts in the 
building have a common place of discharge to the outer 
air. The size of these shafts, with their openings from 
the room, should correspond with those of the fresh-air 
inlets. They should have as few turns and angles as 
possible ; they should not be placed near the inlets, and 
they should lead unmistakably to the outer air. Their 
usual position is near the ceiling, where the most viti- 
ated air is supposed to accumulate ; but there is also 
excellent authority for downward ventilation, especially 
in schools. In some school-rooms multiple outlets, all 
leading to the main shaft, are arranged in the floor be- 
neath the seats, with a view to withdraw the expired air 



60 VENTILATION AND WAEMING. 

from the place of its vitiation as nearly as possible. 
These outlets and ducts should be provided with a suffi- 
ciently powerful extracting force to overcome the cur- 
rent of heated air which Avith each expiration tends to 
rise rapidly. If this expired air rises and then cools 
and falls, the chance is offered of rebreathing it with all 
its impurities present. 

Thus far we have studied two of the essential ele- 
ments in the problem of ventilation ; we have provided 
inlets for fresh air and outlets for foul air ; but some 
force must also be supplied to keep the air in motion in 
the right direction, so that the supply of fresh air, on 
the one hand, shall be continuous, and that the vitiated 
air, on the other hand, shall be as continuously with- 
drawn. And in this important requirement lies the 
germ principle of artificial ventilation. The methods of 
accomplishing this end are two : either the air is driven 
into and through a room or building, the so-called system 
of propulsion or plenum ventilation ; or it is extracted 
from the room or building by the vacuum or exhaustion 
system. The usual, as it is also the simplest and the 
best, method is that by exhaustion, the motive force be- 
ing applied to the out-going foul air instead of to the 
in-coming new air. And of all the forces at our disposal 
there is none that can rival the application of heat for 
this purpose. The principle here applied is a constant 
one, no matter in what form you may find it. It con- 
sists in heating the air contained in the foul-air shaft, 
and so developing an upward current of greater or less 
activity, whose action tends to suck in, at all the points 
of ingress to the shaft, relays of air from the adjacent 
apartment. 



VENTILATION AND WAKMING. 61 

The fire-place with its cliimney is the best type and 
illustration of this method, although it is hardly practi- 
cable for school j3urposes. There is a constant current 
up the chimney, when the fire is burning, corresponding 
in force with the size and height of the chimney and 
the degree of heat from the fire. Concentric currents 
of air in the room tend toward this outlet, to be with- 
drawn with the smoke up the flue. With all its advan- 
tages for purposes of warmth, I would yet extol the 
open fire-place as a " ventilator," and as in that respect 
performing its highest functions. 

And the moral effect of the open fire ought not to be 
forgotten while we praise it for the health and comfort 
which it promotes. The poet's pen and the painter's 
brush have recognized this, and have given a special 
attractiveness to the fireside. The hearth-stone has be- 
come synonymous with the home, and is associated with 
the most intimate domestic relations. But the associa- 
tion dwells rather in tradition than in any present fact. 
The poet's rhapsody and the painter's fancj' could never 
be inspired by the hole in the floor which we call a 
"register," or by the rattling columns of the steam 
radiator. Let us by all means, in our homes at least, 
have the open fire-place, whatever else we have to pro- 
mote pure air, equal warmth, and good cheer. 

A modification of the fire-place and smoke-flue arrange- 
ment for the discharge of the foul air is the use of a 
chimney, not as a smoke-flue, but as a shaft or ventiduct. 
This shaft is heated by a fire at the bottom, and just 
above the fire there enter the foul-air pi^jes coming from 
the different rooms. Dr. Held for several years venti- 
lated the Houses of Parliament in this manner, and so 



62 VENTILATION AND WARMING. 

powerful was the up-draught that, it is said, he could 
change the entire air of the building in a few minutes. 
In Gen. Morin's plan for heating the public buildings in 
Paris, the boiler for heating the water for the steam- 
pipes was placed at the bottom of the foul-air shaft, and 
the air of the shaft was still further warmed for induc- 
tion purposes by coils of pipe arranged within the shaft 
before they were carried to the various rooms. Still 
another effective method is to construct alongside the 
constantly heated smoke-flue another flue which shall 
serve as an extraction shaft, the chimney imparting suf- 
ficient heat to the shaft to maintain an upward current 
in continuous action. Another arrangement utilizes the 
smoke-flue by making this flue of iron, and placing it 
within an ample shaft into which the foul-air ducts from 
the various rooms discharge. 

In schoolhouses, it is generally thought to be sufficient 
to make the shaft, cut the square holes in its side, and 
trust that the foul air of the room will instinctively find 
its way to its proper exit and courteously withdraw 
from the premises. No means whatever are, as a rule, 
applied to coax the current in the right direction. 
There is no steady up-draught in these long boxes to 
promote ventilation by exhaustion, by drawing the 
heated and vitiated air through the apertures, and send- 
ing it on its way to the roof. The remedy is simple if 
the architect would think of it and the janitor would 
apply it. Let there be placed within the shaft, at the 
bottom and along its course, gas-jets or oil-lamps, con- 
stantly lighted. The heat from these would make the 
desired upward current, and the problem would find its 
solution, with rare and readily-understood exceptions. 



VENTILATION AND WARMING. 63 

If this application of heat, or its equivalent, is omitted, 
the ventilator is a delusion and its practical usefulness 
is a matter of chance. 

We have now considered the elementary principles 
of the combined problem of warming and ventilation. 
In this study, I have tried to keep in mind the funda- 
mental objects in view, and the simplest method for the 
attainment of those objects. Of course the principles 
enunciated are susceptible of great varirty in their 
practical application. Into all these matters, touching 
the details of appliances and construction, I have not 
thought it necessary to lead you. It has been my 
object, rather, to show you that in every scheme of ven- 
tilation, natural, artificial, or composite, three things are 
imperatively essential : first, a proper inlet for fresh air ; 
second, a proper outlet for used air ; third, proper man- 
afjement of heat at the inlet and the outlet. Failure 
may generally be attributed to a greater or less neglect, 
either in construction or in administration, of one or the 
other of these essentials, which, simple as they seem to 
be in statement, are, nevertheless, frequently over- 
looked or ignored in practice. 

I venture to add in conclusion half a dozen compre- 
hensive practical maxims which teachers may usefully 
remember in their management of the ventilation and 
warmth of their school-rooms. 

I. The purity of the school-room air is the one thing 
most emphatically to be desired ; hence, — 

II. The teacher should never close the register or 
the valve behind the steam-coil, these being the only 
inlets for fresh air when the windows are closed. 

III. The teacher should keep the sliding door or 



64 VENTILATION" AND WAEMING. 

register into the foul-air ventilating shaft always open, 
that being the outlet for the used or vitiated air. 

IV. The temperature of the school-room should be 
maintained, as nearly as possible, at 68° Fahr. ; and a 
thermometer on the teacher's desk, or in some other 
easily accessible situation in the room, should be the 
only guide for determining the warmth, and this guide 
should be frequently consulted. 

V. School-rooms are generally too warm. If the 
thermometer indicates 70° or more, raise the lower sash 
of one of the windows, and place under it, so as to fully 
close the lower aperture, a thin board ; the air enters 
between the upper and the lower sash, and does not 
cause a draught which can be felt. 

VI. At every intermission in the school-exercises, 
the windows of every room should be opened at the top 
and bottom, for a longer or a shorter time, according to 
the external temperature, in order that the entire body 
of air may be renewed thoroughly. But it is always 
unsafe and imprudent to open the windows while the 
scholars are sitting quietly in their seats, since the free 
and sudden admission of a full blast of cold air is 
almost as harmful as continued breathing of unrenewed 
air. 



THE EYES OF SCHOOL CHILDREN. 

By CHARLES H. WILLIAMS, M.D., 

Ass't Surgeon Mass. Charitable Eye and Ear Infirmary. 



Since all our knowledge of books comes to us through 
the eyes, it is of the greatest importance both to the 
teacher and the scholar to use every means to protect 
the eyes from injury and to increase their usefulness, 
and I wish to call your attention in this paper to some 
of those changes which are most likely to be developed 
in the eyes during the school years, as a result of 
study, or which, existing from birth, form a constant 
hindrance to the free use of the eyes on books. 

The greatest danger to the health and usefulness of 
the eyes that comes from our present methods of edu- 
cation is the alarming increase in the development of 
near-sightedness. This may be seen on a large scale 
among the Germans, for nearly sixty per cent of their 
scholars over twenty-one years of age are near-sighted. 
The prevention of this condition is now occupying their 
most serious attention, for near-sightedness or myopia, 
as it is more properly called, is not a mere inconven- 
ience ; it is caused by changes in the shape of tlie eye- 
ball, and these changes are generally accompanied by 
diseased conditions of the internal parts of the eye, 
which tend to increase rapidly during the school years, 
and in extreme cases may even lead to blindness: a 



66 THE EYES OF SCHOOL CHILDEElSr. 

strong tendency is also developed to transmit these 
changes from parent to offspring. 

A healthy normal eye is nearly spherical in shape, and 
when at rest sees distant objects distinctly ; for by the 
nice optical adjustment of its anterior parts, parallel 
rays of light are brought to a focus exactly on its 
retina; but in the near-sighted or myopic eye the shape 
of the eyeball is changed by being lengthened back- 
wards, thus becoming more egg-shaped, the rays of 
light are no longer focussed on the retina but at some 
distance in front of it, and distant objects are not seen 
distinctly, unless by using a concave glass we get such 
a divergence of the rays of light entering the eye that 
they are brought to a focus further back. 

This increase in length, which may even reach 8 mm., 
is not the only alteration which occurs in a myopic eye. 
There are other and more serious changes which often 
take place in the delicate structures about the entrance 
of the optic nerve into the eyeball, and in some cases 
the retina itself may become so much affected as to 
destroy its perceptive power. 

The exact means by which these changes are brought 
about is even now a disputed point; all authorities 
agree, however, that long-continued work at short dis- 
tances during childhood will cause them, and it seems 
probable that this work causes a congested state of the 
blood-vessels of the eye, especially when the head is 
kept bent forward, and the hygienic surroundings are 
bad, which leads to a slow form of inflammation and a 
diminished resistance of the tissues of the eyeball allow- 
ing them to give way and alter thgir shape more easily. 
Another cause is the lateral pressure of the muscles 



THE EYES OF SCHOOL CHILDREN. 67 

which are used to turn the eye in any direction and 
keep it fixed upon its work; these six muscles are 
attached to the white outer coat of the eye, and to- 
gether they form a funnel-shaped opening in which the 
eye rests. Now when the eyes are turned constantly 
inward, as in reading, these muscles press upon the 
equatorial region of the eyeball, and by increasing the 
intraocular pressure, cause the ej^es to give way at their 
l)osterior part where they are least supported, and so 
cause a continual lengthening backward of the axis of 
the eye, which goes on during the years of greatest 
bodily development, say from twelve to eighteen, with 
increasing rapidity, and if it reaches a high degree, may 
continue to progress afterward notwithstanding every 
care. 

These changes are not confined to alterations in the 
shape of the outer membranes of the eye, for if we 
examine the interior structures with the ophthalmo- 
scope, we find other and more serious alterations. Gen- 
erally the parts about the optic nerve are thinned and 
altered in their structure, and these changes may extend 
to the central portions of the retina, causing a great fall- 
ing off in the acuteness of sight, and making reading 
difficult or even impossible. In some extreme cases 
the retina, unable any longer to follow the other tissues 
of the eyeball in the extension backward, is separated 
from the parts beneath, and the eye then becomes 
suddenly and permanently blind. 

These changes in the deeper parts of the eye creep 
on insidiously, for there is no outward sign by which 
they can be recognized ; but that you may not think 
them uncommon, the figures of Steffan showed that of 



68 THE EYES OF SCHOOL CHILDREN-. 

507 near-sighted eyes, 42.4 per cent had the changes 
mentioned as occurring about the optic nerve, and in 
14.42 per cent the central portions of the retina were 
also affected. 

In investigating the causes of blindness, Cohn found 
that separatiozi of the retina occurred in 4.6 per cent, 
and the central changes in the retina resulting from 
myopia in 6.3 per cent of the cases, blindness being 
considered as such a falling off in the acuteness of sight 
that the eyes could no longer be used to work with. 

The principal cause of these near-sighted changes is 
the long-continued use of the eyes on near objects dur- 
ing the years of most active bodily development, say 
from twelve to eighteen. At the age of eight there is 
very little myopia. Dr. Cohn found about one per cent 
among young German children in a village school. 
Drs. Loring and Derby found among the school chil- 
dren of New York, from six to seven years old, three 
and a half per cent ; but as the children grow older and 
use their eyes more constantly for book-work, the in- 
crease is very great. Dr. Conrad found among German 
school-children of nine years, 11 per cent of myopia ; at 
eighteen it had increased to 55 per cent, and at twenty- 
one years to 62 per cent. Dr. Loring found among 
American children of corresponding ages 3.5 per cent, 
20 per cent, and 27 per cent. 

The following table of Dr. Cohn is especially instruc- 
tive, for it shows not only the marked increase in the 
number of myopic eyes in the higher schools, but also 
the steady increase in the grade or amount of the 
near-sightedness in the different schools. 



THE EYES OF SCHOOL CHILDREN. 



69 



Country schools . . 
Primary " . • 
Intermediate schools 
Polytechnic " 
Latin " . 

Universities . . 



Average per- 


Average 


centage of 


aiuouiit of 


myopia. 


tlie myopia. 


1.4 


h 


6.7 


^V 


10.3 


1 
2^ 


19.7 


.V 


26.2 


1 


59.0 


1 



In this increase of near-sightedness there is, however, 
one fortunate limitation, for after adult life has been 
reached, and the school and college work has been com- 
pleted, this increase of myopia generally comes to a 
standstill, unless the changes have already been extreme ; 
and if one has reached his twenty-first year without de- 
veloping any near-sightedness, there is very little chance 
of beginning these changes even with a large amount of 
near work. For instance, among watchmakers, jewel- 
lers, and others whose occupation obliges them to use 
their eyes constantly at short distances, there is only a 
small proportion of near-sightedness, but these men 
generally begin their special work after they have passed 
their eighteenth year, when the tissues of the eye and of 
the body have acquired a firmness and maturity ; and 
also much of their work is done with the aid of a magni- 
fying-glass, which lessens the danger, and relieves to 
some extent the strain upon the ocular muscles. While 
the eyes are well and strong we are apt to forget how 
very complicated a process reading is; for the different 
muscles of the eye work together so quietly and with- 
out any voluntary effort that it is only when we over- 
task them that we begin to discover their complexity of 



70 THE EYES OF SCHOOL CHILDREN. 

action. When a child reads a book, two sets of muscles 
are brought into play. With one set the power of the eye 
is increased by changing the shape of the lens, so that 
the rays of light from the book are brought to a focus 
properly on the retina ; by the other set the axes of the 
two eyes are turned toward each other so that they are 
united at the point looked at, and with the eyes in this 
relative position they are made to follow the lines of 
print back and forth across the page. 

This intricate muscular action can be carried on un- 
consciously by a normal eye for a reasonable length of 
time, but if we try to prolong the use of the eyes hour 
after hour without sufficient interruptions, we find that 
the eyes become congested, that they begin to be painful 
and tired ; and if the child is young, that we are begin- 
ning to lay the foundations for myopic changes. 

If the scholar bends over his task, resting the head on 
the hand, or if he strains the eyes by reading bad print 
with insufficient light, he only increases their congestion; 
and if when the school hours are over he has no out- 
door game to rest his eyes and give him bodily vigor, 
but goes home instead to prepare his lessons for the 
morrow, he may be adding something to his present 
stock of knowledge, but he is doing it with the chance of 
lessening the power of his most important sense of sight. 

The popular idea that near-sighted eyes are stronger 
than others is a mistake ; it comes from the ability which 
they have to see small objects, such as fine embroidery 
or print with greater clearness than other eyes, owing 
to the work being held nearer the eyes, and the images 
on the retina being larger. Again, these myopic eyes do 
not have to put on glasses for reading at an age when 



THE EYES OF SCHOOL CHILDREN. 71 

other people require tliera, but this ability must not be 
presumed upon ; for the strength of such eyes is only 
apparent, and no account is taken of the deeper seated 
changes which they have often undergone, or of the 
danger of more extensive complications which may re- 
sult in case they are abused. 

To show what effect the increase of hours of study 
seems to have on the eyes of children, Erismann found 
as one result of his examinations, that of those who 
studied two hours daily seventeen per cent were my- 
opic, of those who studied four hours there were twenty- 
nine per cent, and of those who had six hours there were 
forty per cent of myopic eyes. These figures were 
taken from German children, and with them the strong 
hereditar}- tendency probably had something to do with 
the large percentage obtained ; for although it appears 
that myopic parents very seldom have children who 
are near-sighted at birth, yet in their descendants 
there seems to be inherent a greater tendency to de- 
velop near-sighted changes, and a greater rapidity in 
their increase. 

In examining the children of some public schools in 
New York, Dr. Loring found that among those of Ger- 
man parentage twenty-four per cent were near-sighted ; 
those of American descent showed nineteen per cent ; 
and those of Irish parentage had only fourteen per cent ; 
while Dr. Callan found among five hundred colored 
children three and two-fifths per cent myopic in one 
school, and one and one-fifth in another. These figures 
seem to show that the children of those nationalities 
where study and eye-work are most common have the 
larger proportionate amount of myopic change ; while 



72 THE EYES OF SCHOOL CHILDREN". 

those accustomed to the greatest amount of out-door 
life, and using their eyes almost entirely for distant 
things, are comparatively free from it. 

It may be said that examining the children in dif- 
ferent classes of a school gives one result, but that it 
would be more conclusive to trace the changes which 
occur in the eyes of individuals, following them through 
their school life. These examinations are much more 
difficult to make, as they involve a series of careful ob- 
servations extending over a number of years; but one 
case reported by Dr. H. Derby will serve as a type of 
such examinations, and shows this progressive change 
to a marked degree. Here both parents were near- 
siglited, so that a strong hereditary tendency existed. 
When the eyes were examined at ten years of age, the 
right was normal and the left had only a slight myopic 
change ; at twelve both eyes were alike slightly near- 
sighted; at fifteen this change had increased three-fold; 
at seventeen it was five-fold ; and at nineteen years of 
age the myopia was seven times as great as at the 
second examination. 

Among the Germans the prevention of near-sighted- 
ness or its mitigation has been carefully considered, and 
the new schools with their many improvements have 
already shown, in some cases, a relative decrease of 
myopia among their scholars. 

• The first requisite of a good school-room is sufficient 
light. This is best arranged so as to fall principally on 
the left side of the scholars ; but it must be sufficient in 
amount, and if the windows on the left do not give suf- 
ficient light, those on the right or behind may be also 
used ; but the scholars should never sit facing the light. 



THE EYES OF SCHOOL CHILDREN. 73 

The school-rooms should be iiigh, both for purposes of 
ventilation and to allow the windows to be carried up 
to such a distance that the desks furthest from them 
may have a good light. The French law of 1880 re- 
quires that the top of the window shall be at a distance 
from the floor equal to two-thirds the breadth of the 
room, and a French commission recommended in 1881 
that from each desk in the school-room there should be 
a strip of sky visible at least thirty centimeters wide, 
measured from the top of the window. This would, of 
course, require an open space about the school, and no 
very high buildings in the neighborhood. A better test 
would be the ability to read the finest test-type at a 
distance of 50 cm. at the most poorly lighted desk during 
the darkest part of the school hours. Cohn found that 
among the twenty primary schools that he examined, the 
percentage of myopia varied from 1.8 to 6.6 in the better 
lighted buildings ; but in those schools that were placed 
in the older portions of the city with narrow streets the 
proportions rose to 7.4 and 15.1 per cent. 

Not Only the height of the windows but also their 
area is important, and many different standards have 
been given for this. Cohn insists on a minimum amount 
of one square meter of window surface to every five 
square meters of floor. Erismann puts the proportion 
at 1 to 4.5, while the Brussels commission require only 
1 to 6. The bottom of the windows should be about 
1.5 meters from the floor. Direct sunlight falling on 
tlie scholars is to be avoided, and a good arrangement 
of curtains is to have them roll both from the top and 
the bottom of the windows. 

The tint of the walls may be of any light color, pref- 



74 THE EYES OF SCHOOL CHTLDEEF. 

erably a light gray, but the ceiling should be white. 
Dr. Fuchs describes a very satisfactory arrangement 
which has been carried out in the drawing schools 
of Liitich, where in each room two electric lights are 
hung half way from floor to ceiling ; under each light is 
a concave mirror large enough to surround the light 
and screen it from those in the room. These mirrors 
throw the light to ,the white ceiling, whence it is re- 
flected as a uniform diffused light over the whole room, 
giving a pleasant illumination which is very comforta- 
ble to the eyes. 

Careful attention should be paid to the seating of the 
scholars and their desks. Fuchs says, " The scholar has 
a proper position when his body is vertical with pelvis 
and shoulders parallel to the edge of the desk, and the 
head straight or only slightly inclined forward. The 
fe^ should rest on the floor and the back be supported 
hj a rest. In writing, only the forearm, and not also the 
elbow, should rest on the desk." In order to accom- 
plish this several sizes of desks will be needed, adapted 
to the different heights of the scholars, or the London 
plan of a desk with adjustable seats and foot-rests could 
be used. The distance from the seat to the top of the 
desk should be two centimeters greater than the space 
from the elbow to the seat when the arm is held at the 
side. The top of the desk should have an inclination 
of about 1 to 6 for writing, and should project backward 
so as to overhang the edge of the seat by two or three 
centimeters ; but as this would interfere with the free 
movement of the scholars in standing up or stepping 
out of their desks, the top should be arranged to push 
forward. The seat should be raised above the floor the 



THE EYES OF SCHOOL CHH^DREN. 75 

length of the child's leg, measured from the sole of the 
foot to the under side of the thigh when the knee is 
bent at right angles; it should be deep enough to sup- 
port the whole length of the thigh, and should have a 
proper support for the back; for not only is myopia 
caused by faulty positions and furniture, but some of 
the commoner forms of spinal curvature may also be 
traced to this source. 

In reading, the book should be held so that the sur- 
face of the page forms a right angle with a line drawn 
from it to the eye, and while reading it is best to avoid 
all stooping positions and to keep the head nearly erect. 
The scholars should not be obliged to keep their eyes 
fixed on their books, but rather be encouraged and in- 
structed to look every little while at distant objects ; for 
by these means the eye is rested, the tension of the mus- 
cles is relaxed, and the congestion of the eye is relieved. 
If one tries to hold his arm horizontally for five minutes, 
he will get a clear idea of the pain and fatigue which 
comes of keeping the muscles in a fixed condition ; yet 
we often call upon the ocular muscles for uninterrupted 
work, not only for a quarter of an hour, but often for 
much longer periods, and, although it may seem a small 
matter, yet this interrupted use of the eyes will enable 
them to work for a considerable time with much less 
danger and pain than would otherwise have been felt. 

The makers of school-books and the committees who 
choose them have something to answer for in increasing 
the number of near-sighted eyes; but in this respect 
American children are more fortunate, for their books 
are generally printed with much better type and on 
better paper than those issued in Europe. 



76 THE EYES OF SCHOOL CHILDREN. 

Among the Germans the confusing text, the bad tjpe 
and paper which have often been used in the books 
for younger children, have been one of the causes of 
the national myopia. In all their scientific books the 
gothic type is now abandoned, and if it were not for a 
national pride in things purely German, this reform 
would probably have extended itself to their other liter- 
ature. 

In selecting school-books care should be taken that the 
paper is sufficiently thick and white, for white paper 
gives a better contrast with the black letters than any 
colored surface, and also reflects more light, thus making 
the page more easily legible. It is interesting to note 
here the distinction that has been drawn between visi- 
bility and legibility by different authorities, for it throws 
some light on the process of reading and on the proper 
standard for print. Javal saj'S a letter is visible as soon 
as it is recognizable as a distinct object even when one 
cannot name it, but it is legible as soon as it can be 
named. Fuehs, however, says, " A letter is visible when 
we see it under such an angle that we can distinguish 
all its parts, so that, for instance, if it was a character 
unknown to us, we could draw it. The letter is legible 
when we can name it. In the latter case we do not 
need to see all the parts ; our practice in reading often 
enables us to guess at the letter when we only see some 
parts of it. This is still more the case with words or 
sentences." " Children generally have a greater acute- 
ness of vision than adults, and can therefore see the 
letters at a greater distance. On the other hand, con- 
tinuous sentences must be held nearer than is necessary 
for adults in order to be legible, for the children are less 



THE EYES OF SCHOOL CHILDREN. 77 

practised in guessing the letters. From this comes the 
necessity of using larger type for the books that are to 
be used in the earlier classes than would be necessary 
farther on." " For the practised eye the legibility of a 
print depends not only on the size (height and breadth) 
and form of the letters, but also on the relation of the 
letters to each other. The legibility generally increases 
with the distance by which the letters and words are 
separated, as well as by the space between the lines." 

Cohn gives as the minimum size of the letter n, 
height, 1.5 mm. ; breadth of different parts of the letter, 
0.25 mm. ; space between two consecutive letters, 0.75 
mm. ; space between the lines, 2.5 ram. ; and length of the 
lines, 100 mm. Other authors give very similar figures, 
putting the space between the words at 2 mm., and 
between letters at 0.5 ram. A good example in which 
these conditions are nearly fulfilled is the history of 
Montcalm and Wolfe by F'rancis Parkraan. Diamond 
editions of books should never be given to children, and 
fine map drawings, or embroidery, or any school work 
that needs to be held at less than 35 cm. in order to be 
clearly seen, should be abolished. 

In many German schools the use of the ordinary slate 
has been given up, for it was found that the contrast 
between the feeble lines made by the pencil and the 
dark background of the slate were so poor that it 
exerted a hurtful influence on the eyes. Horner deter- 
mined the proportion of visibility of letters thus written 
on a slate to those drawn on paper with ink as 3 to 4. 
Instead of these, Avhite slates made of some composition 
by Thirben of Pilsen have been adopted in many places, 
and the visibility of writing on these as compared to the 
black slates is stated to be as 8 to 7. 



78 THE EYES OF SCHOOL CHILDEEN. 

In kindergartens the use of finely-perforated cardboard 
on whicli patterns are made by counting the holes back 
and forth and passing colored threads through them, is 
often trying to the eyes ; and in the earlier instruction 
in sewing it would often be found easier to use a black 
thread and white cloth in order to avoid unnecessary 
labor for the eyes, and to enable errors to be more easily 
detected. Sewing on white is difficult enough, but 
when we have a black cloth and a black thread there is 
so little difference between the background and the 
work, and so little light is reflected from it to the eye, 
that the task becomes a very trying one. 

In the study of geography the names of places are 
often rendered indistinct by the coloring of the maps or 
the fineness with which they are engraved, and instead 
of expecting the scholar to spend long evening hours 
hunting for unknown places in his atlas, would it not 
be better that he should have the places first shown to 
him on the wall-maps, and their importance fixed in his 
mind by some associated historical or commercial facts 
which would excite his interest and assist his memory. 

If we compare the amount of w^ork that is laid out for 
the children of our public schools to-day with what was 
expected of them fifty years ago, we shall see how much 
the burden on their eyes has been increased, and we 
must expect that unless the eyes have gained in strength 
in order to bear this additional work, that they will 
show evidences of the strain, and tend to develop into 
a myopic state, which seems to be actually the case. 
Fachs in speaking of the causes of myopia, says it is not 
alone the German text, or the print, or the influence of 
nationality, but especially the overburdening of the 



THE EYES OF SCHOOL CHILDREN. 



79 



scholar with work. Diirr gives a very striking table of 
the hours of study as compared to the hours of exercise 
among German, French, and English boys. 





Study hours from 
the age of 10 to 19. 


Hours for exercise 
between Bame ages. 


England 


16,500 
19,000 

20,000 


4500 


France 


1300 


Germany 


650 



In the lowest classes of the primary school three 
hours of study, during which the children are required 
to sit still, should be sufficient, and the amount can be 
increased in the higher classes. From fifteen to thirty 
minutes of every hour should be devoted by the lowest 
classes to some form of intermission, either singing or 
some form of exercise. 

In the grammar and high schools the amount of work 
should be carefully graded, and the amount of home 
lessons should be kept within reasonable bounds. The 
Strasburg commission asked that the hours of home 
study for these schools be limited to three hours a week 
for the lowest classes, and from twelve to eighteen 
for the upper classes. In Berlin some high school 
classes have thirty-three hours a week of home les- 
sons, and in the Dresden technical school it is reported 
that thirty-six hours a week of home lessons are ex- 
pected. 

Too much stress cannot be laid on the need of 
moderation in the amount of home-work required of a 
growing child, for with this increase of work comes our 



80 THE EYES OP SCHOOL CHILDKEN. 

greatest and most serious development of myopia. We 
must remember that this work is generally done by arti- 
ficial light, often poorly arranged and insufficient in 
amount, and it comes at a time when the eyes are al- 
ready tired with the work of the day ; and if the unfor- 
tunate student is obliged to devote a part of his play- 
hours to these tasks because he cannot use his eyes by 
evening light, he is still more to be pitied, for he thus 
does double injury by cutting oif tlie out-door exercise 
which would help him to cure the evil, and by taking 
instead more eye-work, which increases the difficulty. 

One of the principal safeguards that English, and to 
a considerable extent American, boys have, as compared 
with Europeans of the same age, is in the greater amount 
of out-door exercise and games that they can indulge 
in ; and in comparing the lesser amount of myopia among 
English boys with those of German parentage, this 
factor is thought to be one of considerable impor- 
tance. 

All these out-door games should be encouraged, for 
by increasing the general health and vigor of the body 
we find that the tissues are firmer and yield less readily 
to pressure, the circulation of the blood is more rapid 
and freer, and the change of shape and the giving way 
of the membranes of the eye are less likely to occur. 
Unfortunately the near-sighted child, finding that he is 
not able to bear his part in many of the games owing to 
his defective sight, often prefers to spend the time with 
his books, and thus adds to the trouble already begun. 

In the way of dress, tight-fitting collars, or other gar- 
ments about the neck that compress the veins, and so 
retard the flow of blood from the head and congest the 
eyes, are to be avoided. 



THE EYES OF SCHOOL CHILDREN. 81 

If all teachers would test the condition of their 
scholars' eyes at the beginning of every year, they would 
be able to distinguish those who were lazy and inatten- 
tive by habit from those where some physical defect 
was the cause, and the record so made from year to year 
would serve as a useful guide to the amount of work 
that should be required, especially of those scholars who 
were shown to have an increasing myopia with decreas- 
ing sight. 

Such a test is easily made by means of a series of let- 
ters of different sizes, such as the scale published by 
Ginn & Company, which is a copy of the scale devised 
by Monoyer of Paris. 

When this card is hung up in a good light, and the 
scholar is placed five meters, or about fifteen feet, distant, 
he should be able to read with either eye, tested sepa- 
rately, the highest letters on the card, and, if he can 
do this, we call his vision normal, or equal to 1. If, 
however, we find that he can only read half the lines, 
we call his vision half the normal standard, or 0.5 ; 
and thus, at the side of each line, are the numbers in 
tenths showing what is the proportion of normal vision 
for the person who can read that line at the given dis- 
tance of five meters. 

If it is found that the sight is defective for the distance, 
but at the same time the child can read small print 
easily when held near enough to the eyes, near-sighted- 
ness is the probable cause of the defect ; but if both the 
distant and the near vision are defective, the trouble is 
due to some other cause. He may have an irregularity 
of shape of the eye, or the eyes may have been impaired 
by some disease. In the latter case no glasses will rem- 



82 THE EYES OF SCHOOL CHILDKEJST. 

edy the defect, and his lessened power of vision must 
call for more consideration on the part of the teacher. 

The size of the test-letters is graded with great care, 
so that there shall be a difference of one-tenth between 
each line, and the whole thing is so simple and accurate 
that scholars ought to have their vision tested as a mat- 
ter of routine, say once a year, and a record kept which 
would be useful to them and to the teachers ; for, as the 
time to help these troubles of vision requiring a proper 
correction by glasses is in their earlier stages, such a 
test would often bring to light defects which could be 
remedied or alleviated, but which might be increased 
by disregarding them. In case any decided want of 
visual power were found, the child could be told to ask 
for medical advice. 

Tlie facts which it is necessary to remember in regard 
to near-sightedness are, that it is caused by a change 
in the shape of the eyeball, that the principal cause of 
this change is the use of the eyes for near work during 
school years, that it tends to increase in amount, that 
when once formed it cannot be cured, although it can 
be helped by the use of glasses, and that the principal 
means to prevent its development or increase are the 
preventive measures and sanitary precautions already 
indicated. Another defect of the eye, which also de- 
pends on an abnormal shape, is hypermetropia, or, as it 
may be here called, far-sightedness. In this case the 
changes are the opposite of those found in myopic eyes, 
the axis being shorter instead of longer, and the eyeball 
being somewhat turnip-shaped. This condition has sev- 
eral advantages over myopia, for it does not tend to in- 
crease and thus to induce serious diseased alterations of 



THE EYES OF SCHOOL CHILDREN. 83 

the eyeball, and during the early years of school life it 
often escapes unnoticed, because the eye is able, to a 
certain extent, to accommodate itself to this state of 
things, and thus neutralize the defect. 

In order to explain this condition and its beai-ing on 
the use of the eyes, it Avill be necessary to say a word in 
regard to the action of this accommodation. 

A normal eye when at rest receives parallel rays of 
light from distant objects, and without effort brings 
them properly to a focus on the retina. When an object 
is held one foot distant, the light which comes from it 
enters the eye as divergent rays, and, if the eye still re- 
mained at rest, these rays would be brought to a focus 
behind the retina, and the object would not be distinctly 
seen. In order to overcome this difficulty, the eye has 
the power of changing the shape of the lens through the 
action of the muscles of accommodation, and, by making 
the lens more convex, it is able to bring these divergent 
rays to a focus on the retina. 

The mechanism of this process, by which the eye is 
able to change its focus from far to near objects, was for 
a long time disputed, and it was not until the beautiful 
experiments of Cramer in 1851, and of Ilemholtz in 
1853, that the true method was discovered. They placed 
a candle at one side of the eye to be observed ; then, by 
carefully watching with an instrument the images of the 
the candle-flame reflected from the front surface of the 
eye and the front and back surfaces of the lens, they 
were able to see and measure the relative displacement of 
these images which took place when the eye was accom- 
modated from a far to a near object, and which returned 
to their first position when the eye returned to rest ; 



84 THE EYES OF SCHOOL CHILDREN". 

and they were not only able to determine that the act 
of accommodation was caused by this change in the 
shape of the lens, but they were able to measure its 
amount. 

Any one can easily convince himself of the action of 
this accommodation by holding a thin veil, say one foot, 
before the eyes, and looking through it at some distant 
object; we can see the distant object distinctly, or, if 
we try to look at the meshes of the veil, we can see 
them also distinctly by using our accommodation, but 
we can in no way arrange it to see both the veil and 
the distant object at the same time. 

Our hypermetropic eye with its shorter axis has to 
use its accommodation even when it looks at distant 
objects, and the effort that such eyes make is often as 
great for distant things as ordinary eyes would make 
for reading. Such eyes can rest only when the person 
is sleeping or when the lids are closed, and the extra 
amount of muscular effort that they are called upon to 
perform renders them peculiarly subject to attacks of 
pain on reading, and to general discomfort. 

When children are quite young, the lens of the eye is 
quite elastic, and can be changed in shape with compar- 
atively little effort ; but as one grows older the lens 
becomes less plastic, and more force is required to accom- 
modate it, until, with normal eyes, at about the age of 
forty or forty-five, one generally finds that a convex 
glass is a decided assistance for reading, as it brings the 
rays partially to a focus, and relieves the eye of just 
so much work. 

The condition of hypermetropia, unlike myopia, is 
often present at birth, but it is not accompanied by any 



THE EYES OF SCHOOL CHILDREN. 85 

diseased condition of the ocular structures, and if prop- 
erly assisted by glasses, such eyes can be depended upon 
for the usual amount of work. In many cases, however, 
we find a decided tendency for such eyes to have an 
inward squint. This is often temporary at first, but 
may become fixed if the hypermetropia is not relieved 
by glasses, for it is found that a certain relation exists 
between the act of accommodation and the convergence 
of the eyes, and that the greater the convergence the 
greater the accommodation. For this reason a child 
who is constantly making a considerable effort to cor- 
rect his h3''permetropia by an extra accommodative effort 
sometimes develops as a result a permanent turning of 
the eyes, or squint. The use of proper glasses to relieve 
him of this extra work will often prevent the eyes from 
turning, or even set them straight if they have not 
become fixed in this position ; but where it has been 
allowed to continue for some time, an operation followed 
by use of glasses is generally needed to set matters 
right, and such an operation should not be unnecessarily 
delayed, for the turning eye, not working with the other 
to see objects looked at, tends to gradually lose its 
power through disuse. 

It is often difficult for a teacher to detect this condi- 
tion of hypermetropia, on account of the ease with whicli 
young children unconsciously correct it ; but when the 
system has been weakened by disease, as by scarlet 
fever, diphtheria, or other trouble, or where the rapid 
growth of the child has temporarily exhausted its vigor, 
a latent hypermetropia will often show itself on account 
of the inability of the weakened accommodative mus- 
cles to conceal it. We then find the children complain- 



86 THE EYES OE SCHOOL CHILDEEIT. 

ing that the print which was clear when they first looked 
at it soon becomes blurred ; the eyes have ' a tired feeling,' 
or are painful after use, or in the afternoon when the 
child is fatigued or the light is insufficient, and when 
tried by artificial light. When such complaints are 
heard the child should have the eyes thoroughly exam- 
ined, to see what the difficulty may be, and, if possible, 
obtain relief. In these cases the use of convex glasses 
is of the greatest benefit. Children with a considerable 
amount of hypermetropia will sometimes get their 
mother's or grandmother's glasses, and find that with 
them they can see much more easily than without ; but 
this has often been treated as a childish notion, and the 
idea that it was not well for the child to put on old- 
sighted glasses so early has often led to postponing the 
needed relief. 

These children often appear inattentive, and while a 
near-sighted scholar reads his book with very little effort, 
the hypermetrope, on the contrary, has to make con- 
stantly increased efforts to see them, and prefers the 
comparative rest which distant vision gives him. 

There is another condition of the eyes which demands 
the attention of every teacher, both on account of its 
frequent occurrence and the difficulty of determining, 
even on careful examination, how much of real and how 
much of simulated trouble there may be. I refer to the 
condition known as weak eyes, or asthenopia, which may 
come in eyes that are anatomically sound, and is rather 
a functional trouble, interfering with their use, and ren- 
dering them unfit for any regular work, than any special 
form of disease. In these cases there is often a con- 
siderable dread of bright light ; the eyes are quickly tired 



THE EYES OF SCHOOL CHILDREN. 87 

when used for near work, and more or less complaint of 
pain is made. This may result from the fatigue brought 
on by too great a strain upon the muscles of accommo- 
dation, or it may come from some irregular change in 
the shape of the eye, or as the result of previous disease 
of this organ, but it more often occurs without any 
refractive error or other change, and then seems to be 
merely a symptom of a general lowering of bodily vigor. 
After attacks of measles, scarlet fever, or diphtheria, when 
the muscular tone, especially of the eyes, has been les- 
sened, this asthenopia is most marked, and it should 
always be borne in mind that while children are con- 
valescing from these diseases they should never be 
allowed to use the eyes continuously for reading, 
painting, or any near work, and that after they have 
returned to school care should be taken not to overtask 
their strength at first. With whooping cough and 
measles the danger to life is so slight that the disease is 
often looked upon as a trivial affair, yet I have known a 
strong young man of about eighteen, who, after an 
attack of measles, was unable to use his eyes for half an 
hour continuously for more than a year, although even- 
tually they returned to their former strength. 

During the years of greatest bodily development, 
when the children are growing rapidly, the strength is 
often sapped, and we get complaints of inability to use 
the eyes. This is the period when there is the greatest 
danger of developing myopia by forcing the eyes to too 
much near work; but unfortunately it comes about in the 
middle of the school curriculum, and both scholars and 
parents are often more anxious to have the child get a 
double promotion or high rank than they are to consider 



88 THE EYES OF SCHOOL CHILDREN. 

and care for the future usefulness of the eyes, and so 
long as they can be made to do the work, they are 
pushed forward. 

In this fine building you have one room devoted to 
the best remedy for weak eyes and bodies, namely, your 
gj^mnasium, and it should be insisted upon that every 
scholar, especially those of a more delicate build and 
near-sighted tendency, should be obliged to use it, care 
being taken to avoid excess, especially in such exercises 
as congest the head and eyes; exercise should not be 
taken in a hap-hazard way, with only the feats of the 
stronger boys as an example, but the supervision 
should be as careful here as in any other department of 
instruction, and the scholars should never be allowed to 
exceed their strength, but should be shown how they 
can best develop and increase it, and so go on from 
the primer to the higher branches of physical exercise. 
At Amherst College this plan of compulsory exercise has 
been in operation for some years, and its results have 
been very satisfactory. 

In the want of opportunities for our girls to enjoy the 
same freedom in out-door games that boys can have, it 
becomes all the more important that some form of gym- 
nastics should be provided for them ; and although noth- 
ing can take the place of exercise in the open air, yet 
it will be a great gain to bring to their attention the 
need of greater care in the use and development of their 
bodies, and the importance of all matters related to 
their health. 

In conclusion, let me urge the need of a discriminating 
care in the treatment of the scholars. We are not all 
born equal ; the eyes of one child will allow it to accom- 



THE EYES OF SCHOOL CHILDREN. 89 

plish with impunity tasks that would be dangerous to 
its neighbor ; and although we may be able in many 
cases to alleviate the trouble, yet the principal care, both 
here and elsewhere, must be taken in the prevention of 
disease rather than in its cure after the harm has been 
done. 



EPIDEMICS AND DISINFECTION. 

By GEORGE B. SHATTUCK, M.D., 

Visiting Physician Boston City Hospitai.. 



Ladies and Gentlemen: — I have been asked to 
speak to you about epidemics and disinfection. Re- 
garded from the single point of view of school-life, the 
subject, though a very important one, could be disposed 
of quite briefly, and need not occupy more than a small 
portion of our time this morning. Regarded, however, 
from the general point of view of the history of epi- 
demics, of their rise, progress, and decline, in different 
countries, at different periods, under different condi- 
tions, social and physical, the subject is a very exten- 
sive one, — more suited to a large volume than to a 
short lecture. 

Do not let me cause you anxiety by this statement. 
It is not my purpose to take more than the exact meas- 
ure of one hour of your patience. But it seems only 
proper that you should, at the outset, distinctly under- 
stand that there is a rapidly growing and developing 
science of epidemiology, just as there is of ethnology, 
of botany, of natural history. 

This being premised, we will allow ourselves a hasty 
glance at the past history of great epidemics, and the 
present problems in connection with epidemic diseases 



92 EPIDEMICS AND DISINFECTION". 

which are now exercising the medical mind, before 
passing on to the local outbreaks of the common infec- 
tious diseases with which you, as teachers, we as doc- 
tors, and all as citizens, have to do. 

We know that, from the earliest historical times to 
the present day, the human race has been ravaged at 
varying intervals by pestilences, varying in intensity 
and at long distances of time in character. 

As climates, races, forms of barbarism or civilization, 
and habits of life have changed, so have disease types 
and diseases themselves changed. As the discovery of 
a new continent is followed by an exchange of such 
fauna and flora as will thrive in other lands, so it is fol- 
lowed, also, by an exchange of such diseases as can 
adapt themselves to other localities. 

By an epidemic, as you well know, is meant a disease 
which is generally prevailing, which affects large num- 
bers of people at the same time, and indirectly there is 
an implication that such prevalence is unusual. A dis- 
ease, on the other hand, is spoken of as endemic when 
continuously present in a locality, to however limited a 
degree. An endemic disease may, it must be remem- 
bered, assume epidemic proportions, as has so often 
been the case in the past in our community with small- 
pox, and still is the case at times with measles, scarlet 
fever, and diphtheria. 

Epidemic diseases invariably belong to the contagious 
or infectious class. The two terms contagious and in- 
fectious, or infective, were originally intended to con- 
vey different meanings, and to apply to different modes 
of propagation ; but as it became evident that there are 
some common diseases to which neither adjective alone 



EPIDEMICS AND DISINFECTION. 93 

is applicable, and which require both, the terms grad- 
ually lost somewhat of their original proper individual 
meaning, and were used loosely and interchangeably. 
For instance, leprosy and itch are contagious diseases 
in the strict sense of being propagated only by personal 
contact, while malarial fever is an infectious disease in 
the strict sense of being propagated only by an atmos- 
pheric taint, or miasm. Typhoid fever, again, occupies 
a position somewhere between the two, and is some- 
times described as a contagious-miasmatic disease. 

But the term contagious having long since drifted 
away from the restricted sense of personal contact, and 
having been loosely applied to diseases propagated 
through the respiration, and otherwise, at a greater or 
less distance, has become discredited among the more 
careful medical writers, and the present disposition is 
to use the word infectious or infective more and more 
generally, and to restrict the term contagious to the 
comparatively limited number of diseases propagated 
strictly by immediate personal contact. 

Another familiar and respected medical adjective, 
long applied to a large class of epidemic diseases, — I 
refer to the term "zymotic," — is also losing caste. 
"•Infectious" is now allowed to do the work of the term 
zymotic, a term which will pass more and more into dis- 
use as the theory of the development and propagation 
of these diseases by simple fermentation gives way 
• before the more recent and probable theory of their 
development and propagation by specific living and 
multiplying animal or vegetable organisms. 

Although epidemics have scourged mankind from the 
earliest times, history occupied itself but little with 



94 EPIDEMICS AND DISINFECTION. 

them until comparatively recent periods. The so- 
called historians were too much occupied with the 
names of kings, and generals, and dynasties, and bat- 
tles, to devote time and labor to mortality tables, or 
the registration of the melting away of peoples from 
more vulgar causes. Moreover, a great epidemic was 
simply an indication of the wrath of the gods, to be 
appeased by the sacrifice of some bullocks or maidens, 
or other vicarious offering. It is undoubtedly a fact 
that, even in times of great wars, more victims among 
the contestants themselves die or are disabled by dis- 
ease, than by wounds received in battle. And yet the 
plague of the middle ages is the first great epidemic 
disease of which anything approaching accurate rec- 
ords have reached us, if we except Thucydides' ac- 
counts of the plague at Athens, — a disease differing in 
important particulars from any known to us at present. 

The plague came from Asia, and ravaged Europe 
about the middle of the fourteenth century. Many of 
you are doubtless familiar with Defoe's graphic account 
of the great plague of London, the pestilence taking 
possession of the city for three years, from 1665 to 
1668, and killing one-sixth of the entire population, 
principally in the first eight months. The genuine 
plague of the middle ages still lingers in Persia and 
parts of Asia Minor, and its increasing activity within 
the last twenty years, as well as its actual appearance 
in epidemic form in south-eastern Russia in 1878, after 
the Russo-Turkish war, have caused those who were 
informed to reflect seriously upon the possibility of its 
reappearance in Europe. 

Since the disappearance of the plague, the most seri- 



EPIDEMICS AND DISINFECTION. 95 

ous epidemic maladies which have afflicted the world 
have been small-pox, 3-ellow fever, and cholera. The 
discovery of inoculation and vaccination robbed small- 
pox of its terrors; but you know how semi-civilized 
people and barbarous tribes, among whom vaccination 
is not practised, are devastated by this disease when 
once introduced among them ; and you whose memories 
go back to 1872 know that even with such a weapon 
of defence as vaccination, it is only at the price of con- 
stant vigilance that immunity is secured. 

Yellow fever is another epidemic disease which im- 
mediately concerns us, in so far as a large section of 
our own country is very frequently threatened by it; 
and you can form some adequate conception of its 
power under favorable circumstances, when I tell you 
that during the few months of its occupation of Mem- 
phis, in the summer and autumn of 1878, it killed as 
large a proportion of the whole population ^ notwith- 
standing the flight of at least one-half before its ap- 
proach — as did the famous plague of 1665 at London, 
during the whole three years of its activity in that 
great city. We have all the hard facts and figures, but 
no Defoe to make them memorable. Fortunately, there 
is an antidote to yellow fever in cold, as there is to 
small-pox in vaccination, and this, in our own country, 
is never very far distant. 

Cholera, though an old disease in India, is without 
authentic records there until the beginning of this cen- 
tur)'^ ; and for Europe and our own continent it dates 
back only to the years 1831-32, since which date it 
has visited us only five times. Boston has been only 
once seriously threatened, and that was in the year 1848, 



96 EPIDEMICS AND DISINFECTION. 

when 611 people died from it. With good management 
the city may hope to escape as well in the future. 

This hasty review of the great epidemic scourges is 
not unprofitable, as showing that it is not, after all, 
from them that we in Boston have much to dread. The 
plague is practically a. disease of the past ; against small- 
pox there is vaccination j the yellow-fever zone does 
not extend to' Boston ; cholera is a very occasional vis- 
itor, and, as previous epidemics show, does not easily 
make itself at home here. Yet if any one of these mal- 
adies were known to be on its way to us, or, much more, 
to have obtained a foothold in our city, our whole popu- 
lation would be thrown into a high state of excitement, 
and no expenditure of money or trouble would be con- 
sidered excessive in combating it, nor should we rest 
until it was stamped out. 

Now, in regard to nothing else is the old proverb that 
" familiarity breeds contempt " more true than in regard 
to diseases. We have three diseases domiciled here in 
Boston, exacting their yearly toll from our population, 
year in and year out, which are quite as dreadful in 
their way as cholera or yellow fever; and yet we are 
content to live on with them as if they were a necessary 
part of the incidents of our daily life, without doing all 
in our power to be rid of them. I refer to diphtheria, 
scarlet fever, and typhoid fever, — all to a considerable 
extent preventable maladies. It is true that they do 
not break out with the same explosive violence as chol- 
era and yellow fever, but this is largely due to the fact 
that a large proportion of the population is being, peri- 
odically constitutionally accustomed to them. When 
they attack a perfectly fresh field they develop the 



EPIDEMICS AND DISINFECTION. 97 

same activity as either of the first-mentioned mahxdies. 
IMoreover, these endemic diseases periodically take on 
epidemic proportions. Again, the harm which a disease 
inflicts is not to be judged simply by its mortality ; the 
length of its course, the subsequent disabilities, the loss 
of time, are all to be taken into account. From this 
point of view typhoid fever is a more terrible disease 
than cholera, although the rate of mortality — about 15 
per cent — is scarcely a third of that of cholera, which 
is about 50 per cent. But a person has an attack of 
typhoid fever, preceded, as a rule, by a period of worth- 
less malaise, varying from a week to two weeks ; and, if 
he is fortunate enough to recover, it is only, on an aver- 
age, after five or six weeks of helpless illness, followed 
by an equal or longer period of inactive convalescence. 
Again, 

Typhoid Fever is a terrible disaster, 

in that it not only disables its victims for a long time, 
but that time is, in the great majority of cases, taken out 
of the njost precious years of life, — between the ages of 
10 and 45 years. These results of typhoid can be, and 
have been, arithmetically computed and stated in dol- 
lars and cents ; or, if you choose, it can be shown that 
the loss of so much activity is equivalent to so many 
more actual deaths, and in this way the real mortality, 
for purposes of comparison with other diseases, can be 
more correctly arrived at. Now, typhoid fever and 
cholera are neither of them contagious diseases ; they 
are both of them preventable if all proper precautions 
are carefully taken and persisted in, and both of them 
probably preventable in much the same way. And yet 



98 EPIDEMICS AND DISINFECTION. 

we are even now preparing against a possible invasion 
of cholera in the summer, although content to jog along 
in much the same careless way with our own domestic 
typhoid fever. 

I could go through the same sort of story in some- 
what the same way in regard to diphtheria and scarlet 
fever, did I not think we were by this time sufficiently 
of one mind in this question to make it unnecessary. 

Now, there is one fact concerning all these domestic 
infectious diseases with epidemic tendencies, except ty- 
phoid fever, — to wit, diphtheria, scarlet fever, measles, 
whooping cough, chicken pox, — which should make them 
particularly interesting to you, ladies and gentlemen, as 
a body of teachers, and especially worthy of your atten- 
tion ; and that fact is that the period of their greatest 
activity in Boston, as elsewhere, coincides with the 
school months, and the great majority of their victims 
are among young people of the school age, who are a 
large part of each day during those months under your 
care and supervision. It is doubtless owing to this fact 
that I have been asked to talk to you on this subject ; 
for the dissemination of these diseases and the epidemic 
proportions they sometimes assume are certainly due in 
no small measure to the intercourse of children at the 
public schools. 

The Board of Health and the city physician are charged 
with the health of the city. We look to them to make 
the dirty places clean and the infected places harmless; 
to hunt up and isolate the sick, and to protect the well. 
All this can only be attempted within the limits of the 
laws, and the laws are only operative in so far as they 
are in sympathy with public opinion. The efforts of 



EPIDEMICS AND DISINFECTION. 99 

health authorities are crippled, unless supported by the 
citizens whom it is sought to benefit. Householders 
and physicians are required to report to the Board all 
cases of specified infectious disease coming within their 
knowledge, and there is a fine as penalty for neglect to 
comply. But if the cases are not reported, the health 
authorities can hardly be held responsible for a continu- 
ance of the causes which favor the development and 
spread of the disease. If there is one good thing which 
a popular form of government should teach, it is self- 
reliance. Under an absolute form of government, the 
people are taught to depend upon a central authority 
to regulate all their affairs for them. It is the boast of 
the American that he knows how to take care of him- 
self. If this is not a vain boast, it should be demon- 
strated in nothing more clearly than in taking care of 
our health, and in preventing disease. The work of 
health authorities should be facilitated and not impeded. 
Our citizens should not require to have immunity from 
disease thrust upon them in spite of themselves. 

The history of small-pox since 1872-73, the date of 
the last epidemic in the city and State, shows what can 
be done in this direction. 

I will ask you to give your attention to the city of 
Boston alone, and I quote from the reports of the 
Board of Health. Since 1872 the health authorities 
have had absolute control of all the means necessary 
for the suppression or prevention of an epidemic of 
small-pox in this city. They possess the means for the 
most prompt isolation, disinfection, and vaccination ; 
and these three measures are enforced in every in- 
stance. The result has been very satisfactory, beyond 



100 EPIDEMICS AND DISINEECTIOISr. 

the occurrence of an isolated case, here and there, which 
has been introduced from abroad; and this notwith- 
standing a decided increase in the disease three years 
ago on the continent of Europe and in England, Avhich 
made itself seriously felt in other parts of this country. 
There have been, therefore, only 25 deaths from small- 
pox since 1873, whilst in 1873 alone there were 302 
deaths. 

Business has not been disturbed by the prevalence of 
this dreaded disease, the loss by death has been very 
small, and the expense to the city trifling. The number 
of deaths from small-pox since 1872 is shown in the 
following table : — 



1873. 


1874. 


1875. 


1876. 


1877. 


1878. 


1879. 


1880. 


1881. 


1882. 


1883. 


302 


2 


1 


2 


4 








1 


6 


8 


1 



Health authorities and physicians have one great 
advantage in vaccination for dealing with small-pox, 
which they do not yet possess for dealing with the 
other infectious diseases. 

From what has been accomplished in the last ten 
years by Pasteur, Koch, and others, in regard to other 
diseases common to men and animals, by inoculations 
with attenuated virus, there are good grounds to hope, 
however, that in time a similar protection may be found 
against other maladies. But in the meantime much 
may be done by isolation and disinfection. 

B,eports from ph/sicians, of cases of scarlet fever, 
were called for by the Board in January, 1877, and at 
the same time an order was passed forbidding children 
attending school from any family in which this disease 
existed. A circular of instructions was also issued and 



EPIDEMICS AND DISINFECTION. 101 

sent to each family where a case was reported. It was 
thought not to be advisable at that time to interfere 
beyond tliese measures with scarlet fever. The record 
then showed an average of 399 deaths yearly, for the 
previous ten 3'ears, from this disease. 

The number of deaths from scailet fever each year 
since 1872 is shown in the following table : — 



1873. 1874. 


1875. 


1876. 


1877. 


1878. 


1879. 


1880. 


18S1. 


1882. 


1883. 


474 269 


534 


458 


104 


68 


149 


33 


35 


75 


211 



You will notice that scarlet fever since 1881 is again 
on the increase. It is not enough to keep children 
from school when actually suffering from this disease, 
but they should be isolated until desquamation, which 
almost always follows scarlet fever, is terminated. At 
the same time, in 1877, that physicians were required 
to report cases of. scarlet fever to the Board of Health, 
it issued the following order : — 

That no child from any family in which a case of scarlet fever 
has occurred, or shall hereafter occur, shall, without a written per- 
mit from this Board, attend any school in this city until the expira- 
tion of four weeks from the commencement of the last case in such 
family. Such length of time shall be certified in writing by a 
physician, or some responsible member of the family, the certificate 
to be presented to the teacher of the school before the child is 
admitted. 

It is my impression that this order is practically a 
dead letter. I know perfectly the difficulties and 
annoyances which its enforcement would involve ; 
but until it, or something like it, is enforced, scarlet 
fever will prevail and frequently assume epidemic pro- 
portions. At the City Hospital we have many cases of 



102 EPIDEMICS AND DISlNFECTIOlSr. 

these infectious diseases, not a few of which come from 
benevolent institutions for the care of orphan or 
deserted children. We are sometimes very much per- 
plexed for want of accommodation for new cases, and a 
proper separation of different diseases. Under these 
circumstances we may be forced to discharge scarlet 
fever patients before peeling is finished ; but the com- 
mon consequence is, that three or four new cases apply 
for admission, as a result of each one so discharged. 
In a word, it does not pay. 

Diphtheria is an infectious disease prevailing very 
largely among young children ; but we have still little 
real knowledge as to its mode of propagation, and still 
less as to its mode of origin. The two most severe 
epidemics in this State developed without special cause 
under precisely opposite conditions, — the one at a 
small mountain town on the highest land at the western 
part of the State, named Florida ; the other at the low- 
lying, sea-surrounded, sandy island of Nantucket. Iso- 
lation and disinfection are, however, fortunately power- 
ful agents in preventing the spread of diphtheria. The 
physicians and attendants at the City Hospital have a 
large number of cases to care for all through the year; 
and yet it is rare that any of them take the disease, and 
in the exceptional instances carelessness in handling 
patients, or imprudence from over-enthusiasm, are 
generally at fault. 

Reports from physicians and householders, of cases 
of diphtheria, were called for by the Board of Health 
in December, 1877, and a circular of instructions issued 
and used as in cases of scarlet fever. 

The deaths from diphtheria increased in number from 



EPIDEMICS AND DISINFECTION. 103 

59 in 1873 to 601 in 1881, and then began to decrease 
as in the following table : — 

1873. 1874. 1875. 1876. 1877. 1878. 1879. 1880. 1881. 1882. 1883. 

59 72 420 577 364 448 391 588 GOl 458 445 

Typhoid fever, cases of which physicians have been 
required to report since 1881, has continued with but 
slight variation from its record of 1872. 

1873. 1874. 1875. 1876. 1877. 1878. 1879. 1880. 1881. 1882. 1883. 

243 202 227 145 156 120 119 154 207 212 198 

The record of deaths from measles presents a greater 
irregularity in numbers, from year to year, than the 
record of any of the other infectious diseases, and is 
as follows : — 

1873. 1874. 1875. 1876. 1877. 1878. 1879. 1880. 1881. 1882. 

16 41 65 2 2 145 2 49 108 25 

In June, 1883, measles were included among the 
diseases to be reported to the Board of Health. 

The law of the State in regard to the attendance at 
school from families where there is sickness is to be 
found in Chapter 64 of the Public Statutes for 1884, 
and is to the effect that : — 

No child can attend school while any member of its family is 
sick with small-pox, diphtheria, or scarlet fever, or until two weeks 
after death, recovery, or removal of such person. 

The latest order of the Boston School Committee is 
based upon tliis statute, and was issued Nov. 6, 1884. 
You are doubtless all familiar with it, but it will do no 
harm to re-read it. 



104 EPIDEMICS AND DISINFECTION. 

At a meeting of the school committee, held Oct. 28, section 198 
of the regulations was amended to read as follows : — 

No pupil shall be admitted to any of the public schools without 
a certificate of a physician that such pupil has been vaccinated or 
is otherwise protected against the small-pox ; but this certificate 
shall not be required of pupils who are transferred from one public 
school to another ; nor shall any child be allowed to attend any 
school in the city while any member of the household to which such 
child belongs is sick of small-pox, diphtheria, or scarlet fever, or 
during a period of two weeks after the death, recovery, or removal 
of such sick person, such length of time being certified in writing 
to the teacher by a physician or some responsible member of the 
family. 

Both the statute and the order are vagne in the use 
of the word recovery, and inadequate (certainly for 
scarlet fever) in the limitation of the time to two 
weeks, A physician's certificate should be required for 
scarlet fever. Of the possible risk in sending a well 
child attending school, to get news of an absent child 
suspected of sickness, you are probably all aware. 
Another statute (Chapter 98) was enacted by the 
State, entitled "An Act Concerning Contagious Dis- 
eases," with the terms of which it is well you should 
be acquainted. It reads as follows : — 

Sect. 1. When a householder knows that a person within his 
family is sick of small-pox, diphtheria, scarlet fever, or any other 
disease dangerous to the public health, he shall immediately give 
notice thereof to the selectmen or Board of Health of the town in 
which he dwells, and upon the death, recovery or removal of such 
person, the rooms occupied and the articles used by him shall be 
disinfected by such holder in a manner approved by the Board of 
Health. Any person neglecting or refusing to comply with either 
of the above provisions shall forfeit a sum not exceeding one 
hundred dollars. 



EPIDEMICS AND DISINFECTION. 105 

Sect. 2. AVhen a physician knows that a person whom he is 
called to visit is infected with sniall-pox, diphtheria, scarlet fever, 
or any other disease dangerous to public health, he shall immedi- 
ately give notice thereof to the selectmen or Board of Health of 
the town ; and if he refuses or neglects to give such notice he shall 
forfeit for each offence not less than fifty nor more than two 
hundred dollars. 

Sect. 3. The Boards of Health in the several cities and towns 
shall cause a record to be kept of all reports received in pursuance 
of the preceding sections, and such record shall contain the names 
of all persons who are sick, the localities in which they live, the 
diseases with which they are affected, together with the date and 
the names of the persons reporting any such cases. The Boards 
of Health shall give the school committee immediate information 
of all cases of contagious diseases reported to them according to 
the i^rovisions of this act. 

Sect. 4. The Secretary of the Commonwealth shall furnish 
the Boards of Health with blank-books for the record of cases of 
contagious diseases as above provided. 

Sect. 5. Sections seventy-eight and seventy-nine of chapter 
eighty of the Public Statutes are hereby repealed. 

The following table compiled from the " Massachu- 
setts Registration Reports " — reports, which, though 
necessarily inaccurate in some particulars, are probably 
fully as reliable as any published in the United States 
— shows the yearly variations in the deaths from a 
certain number of epidemic diseases affecting especially 
the young for fifteen years, from 1869-1883 inclusive. 
Tlie total deaths from these diseases throughout the 
State in each year is also given ; and the changes in 
population are appended at intervals of five years.^ 

1 At the lecture a large chart was exhibited, showing graphically 
the yearly variations in the mortality from these and other diseases 
for thirty years, from 1854, the first year of State Registration, to 1883 
inclusive. The first twenty-five years of this interesting and instructive 



106 



EPIDEMICS AND DISINFECTION. 





Years. 


s 

>> 




P . 
2g 


§ 
o 


5 


a> 
1 


.5 

a 
m 


II 


o 

"a 
S 
m 


Totals. 


Population. 


1869 


481 


1205 


320 


473 


296 


222 


1405 


1424 


59 


5885 




1870 


471 


1333 


330 


434 


242 


269 


683 


1914 


131 


5807 


1,457,351 


1871 


389 


1116 


243 


473 


274 


131 


867 


1718 


295 


5506 




1872 


564 


1703 


363 


480 


273 


428 


1377 


3254 


1029 


9471 




1873 


435 


1406 


264 


435 


310 


180 


1472 


2553 


668 


7723 




1874 


366 


1147 


449 


411 


502 


161 


1382 


2322 


26 


6766 




1875 


437 


1059 


242 


680 


1200 


233 


1684 


2606 


34 


8175 


1,651,912 


1876 


417 


881 


192 


684 


2610 


47 


1222 


2087 


31 


8171 




1877 


580 


814 


369 


544 


2634 


135 


467 


1927 


26 


7496 




1878 


602 


679 


400 


583 


1934 


305 


404 


1573 


2 


6482 




1879 


372 


637 


302 


559 


1734 


9 


850 


1349 


7 


5819 




1880 


395 


882 


230 


625 


1769 


236 


574 


2118 


38 


6867 


1,783,085 


1881 


360 


1072 


217 


677 


1706 


230 


397 


1861 


47 


6567 




1882 


398 


1079 


265 


491 


1280 


68 


318 


2159 


45 


0103 




1883 


336 


860 


137 


530 


1091 


321 


575 


1941 


5 


5796 





It is evident from the facts presented that all these 
infectious diseases have their periods of increased 
activity, of epidemicity, whenever they find ready to 
hand a large amount of fresh material to work upon. 
What is practically most wanted, — especially for those 
diseases against which no method of inoculation has 
yet been developed, — as the Board of Health, the 
superintendent and physicians of the City Hospital, 
and of late the daily press, have repeatedly urged and 
proved, is sufficient hospital room for the proper care 
and isolation of every case as soon as the Board of 

chart were made under the direction of Dr. C. E. Eolsom, when secre- 
tary of the State Board of Health, and the last five years were added 
to complete the chart to the date of the last Registration Report. 

G.B. S. 



EPIDEMICS AND DISINFECTION". 107 

Health shall decide that it cannot be properly isolated 
at home, and that its condition will permit of removal 
to a hospital without danger to the patient's health. 

There would be no hardship in thus removing the 
patient, but in very many instances it would be the 
means of saving life, and the city would be but doing 
what is imposed upon her by statute law. 

All those most competent to judge in this matter, 
and best acquainted with the necessities of the situa- 
tion, insist upon the advisability of adding to the present 
Cit}' Hospital buildings another or others of sufficient 
capacity to accommodate not less than one hundred 
patients with infectious diseases, this to be so arranged 
as to isolate safely at least three different diseases at 
the same time. And it will only be with such accom- 
modations that such diseases can be successfully op- 
posed, and the mortality and disability from them 
materially and permanently reduced.^ 

Of course you understand that the number of deaths 
from any of these diseases in a given year is not always 
an exact indication of the number of cases. The viru- 
lence of the poison may vary from year to year, but in 
a succession of years the number of deaths is the most 
accurate way of representing the prevalence of a dis- 
ease, for the deaths have to be reported, — although 
they may be attributed to a wrong cause, — whereas 
the cases often are not reported at all. 

* Since the delivery of this lecture the city government has made 
an appropriation of §40,000 for the erection of additional accommoda- 
tion for tlie isolation of infectious diseases at the Boston City Hospital. 
The amount appropriated was only half that demanded, and this appro- 
priation was finally secured in spite of some astonishing opposition. 

G. B. S. 



108 EPIDEMICS AND DISINFECTION. 

The time may come when the authorities will be 
persuaded of the wisdom of providing special medical 
supervision for the public schools of Boston.^ At pres- 
ent such supervision as is given is through the Board of 
Health acting under encouragement or discouragement 
of the school committee, and with the cooperation of 
the truant officers. Under such an arrangement the 
intelligent interest and zeal of those whom you repre- 
sent, ladies and gentlemen, — of the teachers, — may do 
much not only for the health of the scholars in the 
public schools, but for that of the city at large. 

In Brussels, although there are many medical inspect- 
ors of the schools, the health department has caused 
to be compiled for the use of the teachers some brief 
instructions as to the first symptoms of transmissible 
diseases ; these the superintendent had printed and 
distributed to the members of the corps of teachers. 
They have lately been translated and distributed among 
the teachers at Cleveland, Ohio, by order of the Board 
of Education of that city. 

A code of rules for the prevention of infectious and 
contagious diseases in schools has also been drawn up 
and published, under the auspices of the " Medical 
Officers of Schools Association " in England. This 
code is designed for the boarding as well as day-schools, 
and is based upon the experience of medical men having 
supervision of large collections of scholars. 

Of course there are exceptional cases to all general 

1 The Boston School Committee has just voted, as these sheets are 
going through the press, to establish an office of "Instructor in 
Hygiene." A thoroughly competent and suitable person should have 
in this position a rare opportunity of promoting the welfare of future 
generations. An incompetent health oflBcer would be worse than none. 

G. B. S. 



EPIDEMICS AND DISINFECTION. 109 

rules, such as those given in these or other instructions. 
As an instance, merely, I may mention that a young 
woman lately came under my care at the City Hospital, 
with a well-marked scarlet fever rash, but without any 
fever or inconvenience whatever from the disease. She 
had been living out in domestic service, doing her work 
until the day of coming to the hospital, and would have 
continued so to do had not her room-mate reported her 
rash to the family, greatly to their alarm. 

As another instance, the little " Brussel's Manual" 
says, in regard to affections of its second class, B., in 
which fever is not always present at the beginning, 
that in the initial stage of these diseases depression of 
spirits is the rule, and there exists a feebleness of mind 
and body, and marked inattention. I am afraid you, 
ladies and gentlemen, observe only too many cases of 
feebleness of body and mind, and especially of marked 
inattention which cannot be explained by any so tem- 
porary cause as developing measles or chicken-pox. 

Such rules can only be applied with discrimination, 
and if sufficiently condensed to be practically useful 
run the risk of sometimes leading to error. 

Disinfection. 
A few words now as to dismfection. All disease- 
poisons are not equally favored or antagonized by the 
same influences, any more than they are propagated 
and disseminated in the same way. Cold, which is 
fatal to yellow fever, and inimical to cholera, is com- 
paratively favorable to small-pox. The germs of some 
of these poisons can be cultivated only in alkaline 
media, of others in acid, and of still others in neutral 



110 EPIDEMICS AND DISINFECTION. 

media. Some of these poisons, as of cholera and 
typhoid fever, are best disseminated when kept moist, 
whilst others, as scarlet fever, are more fruitful in the 
dry state. Some of these poisons are given off from 
and are absorbed by the alimentary canal, as in cholera 
and typhoid fever, and in such diseases the discharges 
from the bowels should be most carefully disinfected, 
or altogether destroyed. Other poisons, as of scarlet 
fever or erysipelas, are given off from or enter by the 
lungs or skin, or any abraded surface. These are pre- 
eminently the infectious and contagious diseases, and 
nothing less than absence from the neighborhood of the 
sick will protect those having a pre-disposition to them. 

In general, nature has provided two excellent disin- 
fectants, which are plentifully supplied, and are quietly 
at work all the time, wherever they are allowed a 
chance. I refer to sunlight and fi'esh air. Oxygena- 
tion of waste products is the process by which they Avork, 
and the same method is pursued in the laboratory by 
experimenters, who seek to attenuate to any given degree 
the virus of a poison, and thus adapt it to inoculation. 

There are, as you know, a great number of chemical 
disinfectants, both simple and complex. To be of real 
value, such a disinfectant must be both cheap and effi- 
cient. And a disinfectant which will destroy the spores 
or germs of one disease, may have no effect or but lit- 
tle upon those of another. Some experiments are now 
being carried on at the chemical laboratory of the Johns 
Hopkins University, under the auspices of the Ameri- 
can Public Health Association, to determine definitely 
the value of the best-known and most commonly used 
disinfectants for antagonizing disease-poisons. Among 



EPIDEMICS AND DISINFECTION. Ill 

such disinfectants, corrosive sublimate, or bicliloritle of 
mercury, from its cheapness, its freedom from odor and 
stain, promises, in the proportion of (say) 1 to 2000 of 
water, as much satisfaction as anything at present in use. 

It is a very common mistake to confound deodorizers 
and antiseptics with disinfectants. A disinfectant may 
be a deodorizer in the sense generally of substituting 
one smell for another, but a deodorizer is very often 
not a disinfectant at all. 

A very iiigh degree of heat — several hundred Fahr- 
enheit — is another method often resorted to, as by 
ovens, or by superheated steam or boiling water, for 
destroying disease-poisons, or disinfecting articles of 
clothing. Dry heat of the same degree is not as effec- 
tual as moist heat, and boiling water is a very efficient 
antagonist to the poisons of most of the common dis- 
eases. When dry heat is resorted' to, a temperature of 
at least 250° Fahr. is desirable. It is by a patent ap- 
paratus, designed for introducing superheated steam 
into the interior of the bales, that it is proposed to 
treat the imported foreign rags as they arrive at our 
ports. It is a debated question whether such bales are 
really prone to be infected or not, but this method by 
which it is said that the interior of the bale can be 
raised to a temperature of 500° Fahr. is supposed to be 
effectual, and, at any rate, may prove quieting to the 
public mind. 

Where articles can be loosely spread out, their expo- 
sure for several hours to the action of sulphurous acid 
gas, chea[)ly generated by burning roll sulphur in a 
tightly-closed room, in the proportion of two pounds to 
every thousand cubic feet of air space, is an easy and 



112 EPIDEMICS AND DISlNFECTIOlSr. 

efficient way of disinfecting them at the same time with 
their infected surroundings, and this is the method usu- 
ally employed for disijifecting sick-rooms. Practically, 
this process proves itself effectual in its application 
against the usual infectious diseases of our Northern 
States? though we have no exact knowledge of the power 
of sulphurous acid gas over individual disease poisons.^ 
It has not been my intention to give you more than 
a brief outline, in a few words, of important points 
which it is well you should have in mind in regard to 
disinfection. Circumstances alter cases very materially 
in this matter, and for the application of general prin- 
ciples to special conditions, Boards of Health, when 
medically advised, and physicians, should be consulted. 

1 Since this lecture was delivered, Dr. George M. Sternberg has 
published results of experiments made with this and other disinfec- 
tants, and in a prehminary report on his investigations made under the 
auspices of the American Public Health Association, he says: "Fumi- 
gation with sulphurous acid gas alone, as commonly practised, cannot 
be relied upon for the disinfection of the sick-room and its contents, 
including bedding, furniture, infected clothing, etc., as is popularly 
believed. And a misf)laced confidence in this mode of disinfection is 
likely to lead to a neglect of the more important measures elsewhere 
recommended. In the absence of moisture, the disinfecting power of 
sulphurous acid gas is very limited, and under no circumstances can it 
be relied upon for the destruction of spores (germ seeds). But 
exposure to this agent in sufficient quantity, and for a considerable 
time, especially in the presence of moisture, is destructive of disease 
germs in the absence of spores. It is essential, however, that the 
germs, to be destroyed, shall be very freely exposed to the disinfecting 
agent, which has but slightly penetrating power." Dr. Sternberg is 
disposed to admit the value of sulphur fumigation after small-pox, 
scarlet fever, diphtheria, typhoid fever, and yellow fever, but thinks 
that not less than three pounds of sulphur should be burned to each 
thousand cubic feet of air space, and the usual precautions for stop- 
ping all apertures should be very carefully attended to. G. B. S. 



DRAINAGE. 

By frank wells, M.D., 

Editor or the Registration Report op the State or Massachusetts. 



n^HE important subject of drainage does not, perhaps, 
-*- justly enter into the practical consideration of 
school hygiene, as far, at least, as it relates to your 
ability to improve the sanitary condition of the school- 
houses and their premises; since, no matter how much 
the proper management of the ventilation and heating 
of the rooms, or the care of the eyes and nervous systems 
of the pupils may be left to your intelligent supervision, 
you certainly can have no voice in the construction nor 
in the regulation of that great hygienic factor, — the 
drainage. And yet, it was thought that this course of 
lectures, which we have had the honor of delivering 
befoi'e you, would not be quite complete without some 
reference to a subject, upon which so much ignorance 
has been, and still continues to be displayed by some 
even of those who are responsible for the proper con- 
struction of dwellings and public buildings. Moreover, 
it would seem that a brief consideration of the princi- 
ples involved in creating a perfect system of drainage, 
and of the evils which arise from a disregard of them, — 
considerations which enter so largely into almost our 
daily lives, — might be instructive, particularly at this 
time, when it is so incumbent upon us all to see that 



114 DRAINAGE. 

our houses are in a good sanitary condition, and that 
we ourselves live in strict conformity with the laws of 
health. Furthermore, I am not so certain that you, 
gentlemen and ladies, in your capacities as teachers, 
intrusted, as you are to a certain degree, with the super- 
^dsion of the schoolhouses and school-rooms to which 
you are assigned, may not or should not be efficient 
agents in the detection of errors or defects in the drain- 
age systems of them, and hence play an important part 
in the prevention of disease, which, as Dr. Austin Flint 
says, is a higher and more useful branch of medicine 
than therapeutics. That many of you are women makes 
no difference, — rather, it does make a difference ; since, 
remaining more at home than a man, supervising the 
domestic economy of the house, you become more famil- 
iar with every portion of it. " There is nothing in 
hygiene," says Mrs. Plunkett, " which a woman cannot 
understand," and too often she awakes to a realization 
of this, and commences her study of sanitation when it 
may be too late to save a life, sacrificed to a disease 
which might have been, with a more perfect knowledge 
of its cause, prevented. 

With these remarks as an introduction, to more clearly 
explain to you my warrant for adding the present lec- 
ture to the course, let us now proceed to the practical 
consideration of its subject. 

It is a sanitary axiom that all water which has been 
introduced under pressure into dwellings or other build- 
ings, such as stables and manufacturing establishments, 
must be removed from them, after becoming fouled 
by the various usages of every-day life. Such refuse 
water is called sewage, and the system by which it is 



DRAINAGE. 115 

immediately removed from habitations, and disposed of 
in a manner to render it innocuous, is termed sewerage. 
By sewers we understand the large underground con- 
duits, which conduct off the fluid, or half-fluid refuse 
which has been discharged into them by the smaller 
channels from houses, factories, etc., which smaller 
channels are more frequently designated as drains. 
Strictly speaking, however, the term drain is used to 
express the structure which carries off the subsoil water, 
by which process the ground is made dry. 

A system of sewerage, therefore, presupposes the ex- 
istence of decomposing and decomposable materials, or 
sanitary filth, — a term which, in its broad sense, is 
made to include, besides the contents of sewers and 
drains, those of pig-stys, manure heaps, compost piles, 
privies, cesspools, etc ; or, as Dr. Simon says, " such as 
eminently the presence of putrescent matter, solid and 
fluid, causing nuisance by its effluvia and soakage." 
The emanation from this decomposition in the presence 
of water and in the absence of light, particularly that 
which is always present in sewers, from which it derives 
its name, is called, though erroneousl}', " sewer-gas." 

As much confusion exists, especially in the mind of 
the layman (if I may use the expression), regarding the 
precise meaning of the terra sewer-gas^ and the relations 
which it bears to certain diseases, it will be necessary 
to dwell a little more fully upon this topic. The diffi- 
culty, I think, arises from the disposition to look upon 
this gas as one of the distinct gases, like oxygen, nitro- 
gen, etc. As such, however, it does not exist ; but 
there is a se[)arate and peculiar emanation given off 
from orsranic matters in a state of fermentation and de- 



116 DRAINAGE. 

cay, which is composed of the following-named gases: 
carbureted hydrogen, carbonic acid, oxide of carbon, 
sulphureted hydrogen, ammonium, nitrogen, etc., etc. 
Of these, carbureted hydrogen is found in the propor- 
tion of 72.88 in one hundred parts. These constituents 
are dangerous, however, only as they produce their 
chemical effects upon the system ; causing, when diluted, 
headache and discomfort, and, in those habitually ex- 
posed to them, a vaguely depressed state of health, or, 
when sufficiently concentrated, instant death. But, as 
dangerous as these chemical poisons are, more deadly 
still are those other agents, given off from filth or de- 
composition, which are known as contagia, morbific fer- 
ments, organisms, microbes, bacteria, or germs. Their 
name is legion, but they all mean the same thing ; they 
mean matters which, according to Dr. Simon, are "not 
gaseous, but, as far as we know, seem to have their 
essence, or an inseparable part of it, in certain solid ele- 
ments, which the microscope discovers in them ; in liv- 
ing organisms, which in their largest sizes are but very 
minute microscoj)ical objects, and at their least sizes are 
unseen even with the miscroscope." 

These organisms, in virtue of their vitality, are indef- 
initely self-multiplying within their respective spheres, 
and hence, "in contrast with common poisons, can de- 
velop indefinitely large subsequent effects from the 
initial doses, which are indefinitely small. Of these fer- 
ments or germs, the putrefactive, of course, are always 
present where putrefaction is going on, as in decaying 
animal matter : while others, though certainly not essen- 
tial to all such putridity, are very apt, and some of them 
very certain, to be found in our ordinary refuse." In 



DRAINAGE. 117 

view, therefore, of the composite nature of sewer-gas, 
which consists, as has been shown, of various gases and 
living organisms, the term seems to be a misnomer. It 
would be more properly styled an effluvium. 

" As it is through the agency of these morbific fer- 
ments or contiuj'ia^'' Dr. Simon continues, " that the 
zymotic or fermentative diseases are produced by filth, 
it is very important that they should not be confounded 
with the fetid gases of organic decomposition." And 
just here is one great source of danger, since so many 
householders think that, when they have used agents to 
destroy bad odors, they have likewise taken away the 
power of disease production. There is nothing more 
fallacious than this, because, although we cannot prove 
that disease ferments, even if they could be isolated, 
are odorous, yet it is very certain that in doses sufficient 
to produce death they are " infinitely out the reach of 
even the most delicate sense of smell, and that, there- 
fore, this sense is unable, except indirectly and insuf- 
ficientl}^ to sound a warning to us in sometimes the 
most serious dangers from morbid infection." 

With the manner in which filth produces certain 
diseases, or with the germ theory of disease, as it is 
usually expressed, a lecture of this kind has but little 
to do, particularly as there exists, even at the present 
day, some difference of opinion among scientists in 
regard to it. All that it is necessary for us to know is, 
tliat most of the leading pathologists now believe that 
particular diseases, such as cholera, typhoid fever, diph- 
theria, etc., do not, as was formerly thought, spring 
into existence spontaneously, or de novo, from filth, 
that is, that filth alone, communicating the elements of 



118 DRAINAGE. 

decomposition, is not sufficient to produce them. On 
the contrary, it is declared that decomposition simply 
increases a tendency to the production of these affec- 
tions, by furnishing a nidus or resting-place, — a favor- 
able soil in which the particular organisms of disease 
multiply and develop, and without which such organ- 
isms become, as a rule, inert and inoperative. In short, 
the theory of to-day, and one which is supported by 
Pasteur, Tyndall, Koch, and Virchow, is that all dis- 
eases, such as cholera, typhoid fever, diphtheria, etc., 
which become epidemic, are produced each by its own 
particular germ, poison or seed (if you prefer the term), 
which is infinitesimal in its size, capable of retaining 
its vitality for an indefinite period, and which can be 
borne long distances without losing its power of spring- 
ing into active existence, when once it meets an appro- 
priate soil. When this seed or germ is introduced into 
the body, it will again produce its own disease, unless, 
in the meantime, it has come in contact with some 
agent capable of destroying its power of reproduction. 
For a practical understanding of our subject, how- 
ever, it makes but little difference whether filth directly 
or indirectly produces disease, since we know for a 
certainty, that unsanitary conditions do bear an accurate 
relation to a particular class of affections, and that they 
inevitably increase the mortality rate of every com- 
munity in which they exist ; whereas, on the contrary, 
the removal of such conditions invariably leads to an 
improvement in health, to a diminution of disease, and 
to a decrease in the death-rate. At the present day we 
never witness such wide-spread and fatal epidemics as 
occurred in past centuries ; we never have to record, in 



DRAINAGE. 119 

civilized countries, at least, such fearful destruction as 
visited Basle in the fourteenth century, when forty-one 
thousand deaths occurred in one epidemic of the plague, 
— a disease which at about the same time carried off 
three quarters of the entire population of Venice, — 
nor such as took place in 1517, when diphtheria — an 
affection which was accurately described by Hippocrates 
as early as 460 B.C. — carried off in the former city two 
thousand persons. 

Two hundred years ago the death-rate of London was 
eighty in a thousand, while now it is but twenty "in 
spite of the great growth of towns and the great crowd- 
ing of her population." England in twenty-tAvo years 
of continuous wars lost seventy-nine thousand lives ; in 
one year of cholera, one hundred and forty-four thou- 
sand, eight hundred and sixty. 

In Great Britain, the deaths occurring in 1842 from 
typhoid fever alone — a preventable disease — outnum- 
bered the losses sustained by the allied armies at the 
battle of Waterloo. Compare Pekin in China, with- 
out any of the modern sanitary systems, with a death- 
rate of fifty in a thousand, with London, where science, 
supported by intelligent and practical cooperation, has 
succeeded in reducing the death-rate to but twenty 
in a thousand. Sanitation has lowered the death-rate 
in Croydon from twenty-five to sixteen per thousand ; 
and when the sanitary works are completed, it is 
expected it will be reduced to ten. 

Having indicated to you in a general way what the 
dangers of filth are, and how great the decrease in 
mortality its removal produces, let us borrow a leaf 
from the records of medical experience, and learn what 



120 DRAINAGE. 

particular diseases are most frequently produced by the 
existence and non-removal of organic decomposition. 
There is one large class, viz., the zymotic, fermentative, 
or infectious, most of vrhich, if not all, seemingly bear 
such an intimate relation to "filth" that they are by 
most observers termed filth or preventable diseases. Of 
this class, those affections v^^hich may be designated as 
diarrhoeal stand out preeminently in their close and 
intimate relations to uncleanliness. Tj'phoid fever is 
looked upon as the great type of interic disorders, and 
as the representative of the so-called filth-diseases., — 
the evidence, as you are all probably aware, being con- 
clusive that it is causec^ or favored by the presence of 
organic decomposition. It is gratifying for us to reflect 
that in Massachusetts the mortality rate from this dis- 
ease, in 1883, was 27 per cent less per ten thousand 
than that for the previous twenty-six years, and indi- 
cated a proportionate decrease of 21.9 per cent, as 
compared with the average for the previous fifteen 
years, — a result which is due to a better understanding 
of sanitary laws, and to a more rigid enforcement of 
them. 

No doubt can exist that cholera and yellow fever can 
be spread, and that to an alarming extent, by unhy- 
gienic conditions, as is jproved by the course of these 
diseases whenever they occur. You have not forgotten 
the history of the cholera epidemic in France and Italy 
last year, nor that of A^ellow fever in this country in 
1878 ; how these fearful scourges fastened upon and 
rioted in the strongholds of filth, — the former in Mar- 
seilles and Toulon, La Spezia and Naples, and the 
latter in New Orleans, and other Southern cities. 



DRAINAGE. 121 

Diphtheria also in some manner seems to be associ- 
ated with unsanitary surroundings, and is always most 
fatal in those localities in which the sanitary condition 
is bad, particularly in respect to drainage, ventilation, 
and cleanliness. In this connection the following cases 
are instructive : Two boys lost their ball down a catch- 
basin in the street. In their attempts to regain it they 
inserted their heads into the hole, and remained in this 
position for some time. In a few days they were both 
attacked with diphtheria. A few years ago an epidemic 
of this disease broke out in a large tenement in a 
neighboring city. Upon an examination being made, 
a broken box-drain was found under the building, 
from which sewage had escaped. A proper drain was 
substituted, and no more cases occurred. 

Scarlet fever is another disease, which, although it 
cannot be said to be purely a "tilth disease," yet it 
certainly does co-exist very often with unsanitary sur- 
roundings, and its prevalence and mortality are lessened 
by attention to hygienic laws. 

Consumption too may be fairly, I think, added to 
the list ; for, wliether we look upon the ninety-five 
thousand deaths, which occurred in the United States 
from this affection in 1880, as due to an epidemic, or 
whether the theory of Koch, that it is communicable b}'^ 
contagion is true or not, it is a fact that the construc- 
tion of sanitary works certainly lowers its rate of 
mortality. 

Apart from the diseases which have been mentioned, — 
and there are others besides, — persons who live amidst 
unsanitary surroundings, instead of being attacked with 
a well marked disorder, are liable to suffer from languor, 



122 DEAINAGE. 

loss of appetite, colic, and prostration. Dr. Parkes says, 
" When sewer-gas penetrates into houses, and particu- 
larly into bed-rooms, it certainly causes a greatly im- 
paired state of health, especially in children. They 
lose their appetite, become pale and languid, and suffer 
from diarrhoea ; older persons suffer from headache, 
malaise, and prostration ; there is often some degree of 
anaemia, and it is clear that the process of aeration of 
the blood is not perfectly carried on." 

It may be very properly asked, as it very often 
is, why, if filth produces disease, it does not in every 
instance ; for filth certainly exists much more fre- 
quently than does its offspring, — disease. 

It is a fact, however, well known to physicians, that, 
of two persons exposed to a disease under similar cir- 
cumstances, one will be attacked by it, while the other 
will escape. Constitution, peculiarities of tempera- 
ment, and the state of the system at the time exert a 
powerful influence in determining any disease. This 
difference of susceptibility is observed in members even 
of the same family, not only in contracting disease, but 
in its fatality. 

Moreover, the same person, owing to a different state 
of health at different times, may be stricken with a dis- 
order, from which at another time he may escape. It 
is a well-established fact, that, in our waking moments, 
when the system is active and vigorous, we may be 
exposed with impunity to baneful influences, which in 
sleep may make an impression upon us. This is proved 
conclusively by experiences in malarious districts. 

In the case of an epidemic of typhoid fever, which 
broke out among some boys, who were watching the 



DRAINAGE. 123 

process of cleaning a drain in Clapham, England, the 
boys only were attacked, while the workmen escaped. 
Long exposure to unsanitary conditions may beget a 
tolerance of them ; or, what is more likely, the influ- 
ence of these conditions is so gradual, that the transition 
from health to sickness is not noticed. 

Before leaving this part of the subject, in order that 
there may be no misapprehension of it, I beg you to 
consider that, in asserting that a definite relation exists 
between filth and the zymotic diseases, I do not mean 
to affirm that in every individual case we must look to 
unsanitary conditions, as the only cause which exists for 
tlieir production. Many of these diseases are conta- 
gious, some of them remarkably so ; and, like a confla- 
gration, when once they have broken out, they may, by 
tlieir contagious nature, be indefinitely spread. 

Recognizing the intimate relation which is now sup- 
posed to exist between certain diseases and "filth," the 
next practical enquiry, having for its object the exter- 
mination of preventable diseases, which arises, is, how 
filth or the germs of disease are carried into the system, 
to produce there a morbid condition. This may be 
accomplished, as may be inferred by what has been 
said, through two channels, viz., tlie stomach or the 
lungs, — that is, we may either drink or eat it, or we 
may inhale it with the air we breathe. In the former 
case it is liquid or solid filth, and in the latter a gaseous 
one. 

Of the water usually supplied to large cities, which, 
unless contaminated by accidental causes or by defective 
plumbing inside the house, is generally pure, but little 
need be said. But we are chiefly interested in the re- 



124 DEAINAGE. 

maining source of supply, viz. from wells, which are now 
used to a limited degree even in cities. The reason why- 
well-water is so frequently bad and unwholesome, is be- 
cause sink-drains, badly-made house-drains, cesspools, 
etc., not unseldom empty their foul contents into them 
by percolation through the soil, particularly if it is a por- 
ous one, and has an underlying structure of clay or rock, 
which forms an excellent bed upon which liquids can 
flow. A frequent source of contamination of well-water 
in the country is by the kitchen slops, containing, as they 
do, elements of decomposition, which are thrown out up- 
on the ground, and which, in course of time, as the custom 
is kept up, must pollute the wells by saturation of the 
soil. The most frequent causes of pollution, however, 
are from cesspools, which are seldom, if ever, made 
tight, and from the ordinary vault, which, of all filth 
influences which prevail against human life, operates to 
far the largest extent. 

So easy is this pollution of water even upon level 
ground, that it is estimated that, whenever dwellings 
are situated within one hundred feet of each other, 
there is danger that the wells may become contami- 
nated through some of the agencies which have been 
already mentioned. Of course the danger is infinitely 
increased, if the wells and the sources of pollution are 
placed more closely together. But filth has been known 
to leach through the soil to a greater distance than one 
hundred feet. Easie mentions a case, in which the con- 
tents of a cesspool poisoned a well two hundred feet 
distant. 

If this will occur when the well and the " filth " 
source are upon the same level, how much more readily 



DRAINAGE. 125 

will contamination take place, if the well is on a lower 
plane. The following striking case reported by Mr. 
Child, Health Officer for a portion of Oxfordshire, Eng- 
land, illustrates this principle : " In consequence of the 
escape of the contents of a barrel of petroleum, which 
had been buried in an orchard, a circuit of wells sixty 
feet below and nine hundred feet distant became so 
affected, that the occupants of fifteen houses, containing 
eighty-two inhabitants, were for ten days unable to 
use the water for cooking or drinking. The cattle of 
one of the proprietors, moreover, refused to drink at 
their accustomed spring." Had this soakage been 
sewage instead of petroleum^ whose presence would not 
probably have been detected, who can doubt that the 
result might have been wholesale water-poisoning, 
followed by an outbreak of typhoid fever ? 

The intimate relation which exists between many 
diseases and well-water has been abundantly proven by 
experience. A few examples of this truth will be 
sufficient. In 1879 a person was attacked with typhoid 
fever in Fairhaven, Mass. His discharges, without dis- 
infection, were thrown into the privy vault, the filth 
from which leached into the well one hundred feet 
distant. In consequence, eight members of the family 
contracted the fever within twelve days of each other. 
The direct communication between the well and the 
privy was proven conclusively by a salty taste, which 
was imparted to the water by a quantity of salt thrown 
into the vault. 

In the cholei'a epidemic, which occurred in London 
in 18G6, the mortality in the East End, which was 
supplied with water from a reservoir, " which was little 



126 DRAINAGE. 

better than an open sewer receptacle," was from sixty- 
three to one hundred and eleven in ten thousand ; 
Avhile in other portions of the city, which were supplied 
with pure water, the mortality was only from two to 
twelve in ten thousand. 

If the pollution of our drinking-water could always 
be made manifest by a disagreeable odor or an unpleas- 
ant taste, the danger to health would be infinitely less ; 
for under these circumstances most persons would 
discontin.ue their contaminated supply. But, unfortu- 
nately, the dangerous character of these waters is often 
indicated neither by the odor nor taste of impurities. 
The fact that a water is clear and palatable is no proof 
whatsoever of its purity, since these conditions have 
been markedly present in some waters most shockingly 
polluted with sewage, as indicated by chemical and 
microscopical examinations. Some of the most un- 
wholesome waters are especially bright, sparkling, and 
refreshing; but the chemical process, which has made 
them so, may have had no effect upon the germs of 
disease which they contain, and which have been known 
to produce the most disastrous results. 

The water of the Aldgate Pump in London was 
always noted for its purity" and its "very pleasant, cool, 
and sparkling taste " ; so much so, that persons resorted 
to it from far and wide on account of its supposed 
medicinal properties. And yet, upon its analysis by 
Prof. Wanklyn, it was found that its refreshing char- 
acter was due to its impregnation with the salts of 
decomposing sewage, which had found their way into 
the well. 

The dangers, arising from the use of polluted water, 



DRAINAGE. 127 

are still further increased by its ability to affect other 
lluids with which it is brought into contact. A number 
of cases of typhoid fever have been caused, both iu this 
country and in England, by milk contaminated either 
by admixture with contaminated water, or by the dairy 
utensils and milk cans having been washed in it. 

In regard to the evil effects which follow the use of 
impure ice, I simply mention the subject to call your 
attention to the fact that, while some organic impurities 
and disease germs may be distroyed by the action of 
cold, yet there are many others which are active chiefly 
during cold weather, and others still, which seem to 
remain latent at such times, only to be revived again 
under the influence of heat. 

Although a chemical analysis may fail in certain 
cases to detect the poisonous character of a water, 
since neither chemistry nor the microscope have as yet 
been able to identify the materies morbi with any degree 
of certainty, yet the following test of Heisch's for sew- 
age or decomposable organic matters will be found very 
reliable : " Fill a clean pint-bottle three-fourths full 
with the water to be tested, and dissolve in it half a 
teaspoonful of the purest sugar (loaf or granulated 
will answer) ; cork the bottle, and place it in a warm 
place for two days. If in twenty-four or forty-eight 
hours the water becomes cloudy or milky, it is unfit for 
domestic use. If, however, it remains perfectly clear, 
it is probably safe to use." 

As dangerous, however, as polluted water is when 
taken into the stomach, more injurious still is the 
inhalation of air contaminated by the products or gases 
of decomposition, since we drink but a few pints of 



128 DRAINAGE. 

water in twenty-four hours, while in the same period of 
time we inhale one or two thousand gallons of air, 
which through the medium of the lungs are taken 
directly into the blood. In fact, this is the only channel 
through which the germs of certain diseases are ever 
carried into the system. 

A single example, taken from the many with which 
the literature of the subject is filled, will suffice to 
illustrate this principle. An epidemic of typhoid fever 
brok^ out in the Boys' School attached to Colchester 
Union, in England. The boys, who were first attacked 
and who suffered the most severely, were those who 
occupied desks which were placed in a direct line 
between a passage, in which there was an uii trapped 
drain, and the fire. The natural tendency of sewer-gas 
to seek the warmest air caused it to pass over these 
desks, with the above result. 

Enough has been said, however, perhaps more than 
enough, to clearly indicate to you the grave importance 
which exists for strict attention to the sanitary condi- 
tion of our surroundings, particularly when the well- 
being of those of tender years, who, on account of their 
more delicate organizations, are more highly susceptible 
to morbid influences, are to be considered. 

I have now explained to you what is meant by 
"filth," how it operates, its relation to disease, and the 
manner in which it is introduced into the system. 
There remains for us to consider the best methods for 
rendering this filth, which is always present, as innocu- 
ous as possible ; and in doing so, I shall confine myself 
to the subjects of sewerage, house drainage, and house 
plumbing. 



DllAlNAGE. 129 

Starting with the sewers, we must presuppose the 
existence of a copious water supply and a scientifically 
planned water system, without which all drainage would 
be worse than useless. For the object of all sewerage 
is to carry off" organic matter as rapidly and as continu- 
ously as possible, in order that, by a speedy removal of 
it, there shall be no opportunity for it to stagnate, and 
by its decomposition to give off noxious vapors. This 
can only be accomplished by means of water. To 
clearly understand this principle, it is necessary for you 
to remember that most materials discharged into the 
sewers are not, at the time of this discharge, in a state 
of decomposition, but that it is only under the com- 
bined influence of dampness, darkness, and non-ventila- 
tion that putrefaction is produced. Hence the rule 
has been established that sewage must be carried off 
entirely within two or three days, since before this time, 
though offensive, it is not by itself dangerous. 

This, then, being the object of a good sewerage sj's- 
tem, — viz., to carry off rapidly all decomposable ma- 
terials, — it follows that the size of the sewers must be 
proportionate to the amount of sewage which is to pass 
through them, as well as to that of the rainfall. The 
one great mistake, which is so often committed, is in 
building sewers as well as drains altogether too large. 
For, although they should always be constructed so as 
to meet every possible requirement of the future, yet, if 
they are built to do more than this, they are defective. 
As it is a well-known fact that a stream of water will 
run more rapidly through a narrow channel than through 
a wide one, so sewage will be more quickly and effectu- 
ally carried off by a small sewer — provided, of course, 



130 DRAINAGE. 

that it is large enough for its work — than by one of 
great size, in which, owing to the sluggishness of its 
flow, its contents would soon become ponded and de- 
posited, and the sides of the conduit remain unsecured. 

Catch-basins, which, as you all know, are receptacles 
placed in the course of the gutters, and connected with 
the sewers in order to carry off the surface water, demand 
but a passing notice. If tliey give out a bad odor, it is 
either because there is some defect in the sewer, which 
allows the filth to become stagnant, or the water-seal in 
the basin has become broken (usually by the water not 
being renewed after cleaning), or the sewers are not 
properly ventilated. 

This reference to the proper ventilation of sewers 
brings us to one of the most important underlying prin- 
ciples of a sewerage or drainage system. That sewers 
and drains should be thoroughly ventilated is, at the 
present day, no longer a question. Easie says, in his 
work on " Healthy Homes," that all theories of drain- 
age, which fail to inculcate the absolute necessity of 
ample ventilation of sewers and drains, are worse than 
useless, — they are even, dangerous. 

In Croydon, England, which possesses one of the most 
perfect systems of sewerage in the world, typhoid fever, 
which occurred periodically, was formerly very frequent, 
and increased in one year the death-rate from 18.13 
to 28.57 per thousand. Diseases, which were for- 
merly confined to the lower portions of the town, 
were carried by the sewers to the upper portions. 
After the sewers had been thoroughly ventilated, there 
was no further outbreak of typhoid fever, although 
the population had been doubled; and the death-rate 



DRAINAGE. 131 

now seldom rises to 16 per tliousand, "a standard of 
health unparalleled in the history of sanitary science by 
a district having so large a population." 

The necessity for this ventilation arises from the great 
lightness an(^ diffusibility of sewer-gas, which in conse- 
quence seeks the highest outlet of escape, unless other 
vents are provided for it; and also from the compression 
and expansion of the air within the sewer. 

This latter result is caused first by a sudden influx of 
water into it, either from a rainstorm or from the usual 
waste of a house. If the amount of water, thus ad- 
mitted, is sufficient to fill the sewer three-fourths full, 
where it had been previously running only one-half full, 
the air, which originally had occupied the remaining 
half of the sewer, must be compressed into one-quarter 
of the sewer, which would increase the pressure upon 
the air by an amount equal to a column of water thirty- 
four feet in height. Of necessity this pressure will be 
relieved by an escape of the air through proper 
ventilators if they exist; otherwise through the various 
openings into our houses, unless these openings have 
been protected more thoroughly than is generally the 
case. 

Compression of the sewer-gas is also caused by the 
temperature of the sewer being raised, either by the ob- 
jectionable practice of letting waste steam escape into 
it, or by the discharge into it of hot water from facto- 
ries, or from the wash-stands, bath-tubs, sinks, etc., of 
dwellings. 

The amount of pressure, which is produced by an 
elevation of temperature from 50° to 150° Fahr., is 
equal to seventeen and five-tenths pounds to the square 



132 DRAINAGE. 

inch, or to a column of water forty and seven-tenths 
feet high, — an increase of nearly three pounds to the 
square inch, or six and seven-tenths feet head of water, 
over the original atmospheric pressure. This additional 
force but few traps can resist, and consequently venti- 
lation becomes a necessity. 

When the volume of water in the sewers is again 
reduced, or a condensation of air in them has been 
caused by a lowering of their temperature by the 
admission of cold water, or by cooling after the hot 
water has passed off, a vacuum is produced, which 
causes atmospheric air at the rate of one thousand 
three hundred and thirty feet per second to be drawn 
in ; and this alternate exhalation and inhalation of air 
is what constitutes the proper ventilation of sewers. 

Other forces likewise contribute to the ebb and flow 
of air in the sewers, such as barometric changes, wind 
blowing over the tops of the ventilators, and the law 
of diffusion of gases. 

The usual method of ventilating the sewers is 
through the man-holes in the centre of the street, 
which are supplied with perforated covers for the 
purpose. It was at one time proposed (and some cities 
adopted the plan) to ventilate the sewers and drains 
by means of the rain-water pipes, which carry off the 
water from the eaves troughs. But this method has 
been found not only impracticable but dangerous ; 
since, just when ventilation is most needed, viz., in 
heavy rainfalls, when the sewer-gas is greatly com- 
pressed by the sewers running nearly full of water, 
these water pipes are likewise full, and consequently 
are entirely inoperative as ventilators for the passage 
upwards of the gases from below. 



DRAINAGE. 133 

That these pipes cannot be depended upon solely to 
furnish ventilation to main sewers, is also evident from 
the fact that, when the sewers are running very full of 
water, the entrances into them of house-drains are 
generally below the level of the water, and conse- 
quently the air in the sewer becomes compressed to 
such an extent, that it soon acquires enough power to 
force a passage through channels the least expected. 
For this reason, ventilation of sewers, by any ventilator 
connected with a house-drain leading into the sewer, is 
at many times ineffectual ; and street ventilators must 
therefore be provided for the purpose. Then, too, the 
rain-water pipes are objectionable, on account of their 
opening at the eaves of the house, which may be in 
such close proximity to windows in the same house or 
in that of a neighbor's, that the gas carried off by them 
will fnul its way into the dwelling. 

Besides, they are very likely to leak, either in their 
joints or seams, thus allowing any gas which they may 
contain to effect its entrance through the windows. 
Moreover, in winter, when the introduction of un- 
healthy emanations into our houses is particularly 
dangerous (since but little air can be admitted, in our 
climate, at least, to dilute them), the conductors are 
usually choked with ice, and consequently useless for 
the purposes of sewer ventilation. 

That these pipes used for this purpose are dangerous 
to health, has been abundantly proved by many in- 
stances. The drain of the U. S. Marine Hospital at 
Chelsea, Mass., was formerly ventilated by means of 
the water i)ipes leading from the eaves trough ; during 
one winter the water in it froze, and as a consequence 



134 DRAINAGE. 

the pipe burst in the neighborhood of a sleeping apart- 
ment. Two brothers of the surgeon-in-charge, who 
occupieci this room in the following summer, died of 
typhoid fever, — a result which was attributed to the 
escape of sewer-gas through the leak in the pipe into 
their sleeping-apartment. 

In Croydon, previous to 1860, the sewers had been 
ventilated by small pipes, particularly at their heads. 
Ill this year, however, a law was passed, compelling 
ventilation by means of water pipes ; whereupon the 
death-rate commenced to steadily increase from 16.63 
in 1861 to 21.26 in 1865. Upon the repeal of the law, 
and the ventilation of the sewers by openings in the 
streets, the death-rate commenced immediately to fall 
from 21.26 to 16.6 in 1869. 

With the shape, material, and outlet of sewers we 
have nothing to do, although these problems of con- 
struction are of great importance to engineers. 

Leaving now the sewers, we come directly to the 
house drains, or the connecting link between the 
plumbing of the house and the main sewerage system. 

These drains are of practical importance to us, since 
any imperfections, which may exist in them, tend to con- 
serve the filth in close proximity to our dwellings. 

The best material for house drains is undoubtedly 
a vitrified pipe, well burned and smoothly glazed, unless 
when the ground is " made." In such cases, on account 
of the liability of the drain to settle and break, when 
made of a perishable substance, iron should be used ; 
as it also should be when the drain has to run in 
close proximity to the well or other source of water 
supply. It is important, however, that the vitrified 



DRAINAGE. 135 

pipe should not be employed beyond a point which is 
well outside the foundation walls of the house. At this 
point iron should be substituted. 

Great care must be taken that the joints of the pipes 
are tight, and not left open from the mistaken idea that 
such openings can be used for carrying off the subsoil 
water. This precaution, which is too often neglected 
by careless or ignorant workmen, is particularly impor- 
tant at the connection between the internal and external 
systems ; since the filth which must be inevitably poured 
out, where the joints are leaky, will thus accumulate 
and saturate the soil in close proximity to the dwelling. 
Moreover, sewage, which has lost some of its liquid com- 
ponents, has been deprived of the force of its flush, and 
hence the solid portion remains in the pipes, to decom- 
pose and fill them with noxious gases. 

One of the most common causes of obstruction in the 
house drain arises from the grease, which is usually, but 
which should not be, poured doAvn the kitchen sink, and 
which, when hot, is fluid, but when cold becomes solid. 
Drains thirty to fifty feet in length have been entirely 
closed from this cause. Hence some provision to arrest 
this material becomes necessary, which is ordinarily fur- 
nished by a receptacle, called a grease trap. If our ser- 
vants could be depended upon to save the two hundred 
pounds of fluid fat, which are in some households an- 
nually wasted by discharge into the drains, grease traps 
would be uncalled for. Even as it is, some sanitarians 
advise against them, preferring to depend upon the 
ordinary trap under the kitchen sink, provided with an 
opening closed by a stopper, for the arrest and removal 
of the grease. For many reasons this plan seems to be 



136 DRAINAGE. 

defective, and hence it would be better, wherfever it is 
possible, to provide a separate grense trap outside the 
house in the line of the drain. This is very necessary 
for all places where extensive cooking is carried on. 
It should be perfectly water-tight, frequently cleaned 
out, and thoroughly ventilated by a grating in its 
cover. In no case, however, should the grease trap be 
located inside a dwelling, since it will in most instances 
become a cesspool, and give out the vapors of decom- 
position directly into the house, unless more carefully 
and frequently cleaned out than is usuall}'- the custom. 

Before proceeding to the next principle involved in a 
system of drainage, let us pause a moment to condemn 
the practice, so commonly in vogue in rural or suburban 
districts, of throwing out slop waters from the house 
upon the ground, or running them in open gutters to 
the nearest pond or brook. It is needless to add that 
such practices are entirely wrong, since, by the con- 
tinued soakings of the ground, the water supply is liable 
to become fouled and the atmosphere polluted. For the 
same reason it is wrong to lead the waste pipe from the 
kitchen sink in such a way, that the waste matters shall 
flow through it upon the ground. 

Another custom, which is very common in country 
districts unprovided with a sewerage system, is that of 
storing the filth of the house in cesspools. As ordina- 
rily built, these receptacles furnish the worst possible 
method for the disposal of the sewage, since they are 
very frequently located close to the house, sometimes 
directly under it; and, being in most cases mere pits dug 
in the ground, they allow the fluids which they contain 
to soak away into the subsoil, while the solids remain 



DRAINAGE. 137 

in them to decompose and generate foul vapors. They 
thus become centres of filth of the worst kind, polluting 
the water which is drunk, and poisoning the air which 
is breathed. 

If, on the contrary, the cesspool is built perfectly tight, 
so that its liquid contents cannot leach into the soil ; if 
it is located at a safe distance from the house, thor- 
oughly ventilated, and frequently cleaned out and disin- 
fected ; if it is small and built in two compartments, — 
one for the fluids and the otlier for the solids, — it then 
becomes reduced to its minimum of danger. 

Resuming now our progress along the drain towards 
the house, Ave shall, or rather we ought to find, a bend or 
depression in the pipe, which, owing to this depression, 
holds water. This device is called a trap, and is an 
example of a very important factor in sanitary drainage. 
A trap is an obstacle, usually of water, placed in the 
line of drains and plumbing fixtures, to prevent, as far 
as possible, the free passage of sewer-gas into the house. 

That some barrier to the otherwise inevitable entrance 
of this gas into our dwellings must be provided, you can 
readily understand, if you will bear in mind the nature 
of these vapors, and the forces which are continually at 
work in the sewers to produce a compression of them. 
As necessary, however, as traps are, they cannot be said 
to be of unmixed good, since they defeat to a certain 
extent the law of perfect drainage, viz., that filth 
must be carried off rapidly and without unnecessary 
obstruction Hence every trap, offering as it does to a 
certain extent an obstacle to a free flow of water, and 
tending therefore to the production of deposits with 
their consequent decomposition, must be regarded as an 



138 DRAINAGE. 

evil, although a necessary one. But traps are made 
more of an evil than they need to be, by the very com- 
mon and objectionable custom of not flushing them 
thoroughly with clean water, after the sewage has passed 
through them. No matter where the waste water comes 
from, the last of it will remain in the trap to give off 
offensive odors, unless for a few minutes clean water is 
allowed to run into the fixture, and thence through the 
discharge pipe into the trap. This latter precaution, 
therefore, should never be omitted. 

Such an infinite variety of traps has been invented, 
that, in selecting the best form, one is very apt to 
become confused. As an aid in the selection the fol- 
lowing principle, expressed by Mr. Hellyer, will be 
found useful : " No sanitary fitting, waste pipe, soil pipe, 
or drain, should be trapped in a way that will not admit 
of the whole of the water being entirely changed every 
time a good flush of water is sent through them." In 
accordance with this excellent rule it has always seemed 
to me that the so-called mechanical traps — that is, those 
which depend upon some device besides water to effect 
a seal — are, with but few exceptions, hygienically 
unpractical, since they offer greater obstacles than the 
simple forms to the free flow of sewage, and are more 
liable to become foul by the deposit of filth in their 
angles and recesses. 

Probably the best trap for house drains and for gen- 
eral use is that which, from its shape, is styled a syj)hon 
or S trap, and which retains in it enough water to form 
an effective seal. It is self-cleansing ; it is the simplest, 
the least liable to derangement, and the most economi- 
cal, — thus fulfilling as nearly as possible, under certain 



DRAINAGE. 139 

restrictions to be mentioned hereafter, all the require- 
ments of a sanitary fixture. 

The place where a trap will be of the greatest ser- 
vice is either just inside or outside the house wall, in 
the main house drain, after it has received all of its con- 
nections ; since, without this barrier, the pressure of the 
gas would, in all probability, force some of the smaller 
and weaker traps above, in the plumbing of the house. 
Dr. Parkes says: "The rule in fact should be, that the 
union of any pipe with the outside drain should be 
broken both by water and ventilation. The simple 
plan of disconnection, if p'roperly done, would insure 
persons against the otherwise certain danger of sewer- 
air entering the house. Houses, which have been for 
years a nuisance from persistent smells, have been 
purified and become healthy by this means." 

A neglect of this simple precaution of trapping out- 
side of the house was said, by the leading physicians 
in England, to have been the cause of the dangerous 
attack of typhoid fever, from which the Prince of Wales 
nearly lost his life at Lownesborough Lodge some years 
ago. 

When this trap is located outside of the house, 
especially in all land where there is danger of settling, 
it is advisable to place around it a man-hole, in order 
that the drain may be easily inspected, and an oppor- 
tunity afforded of clearing away any obstruction which 
may have occurred at this point. It is also advisable to 
run into this trap the rain-water conductor, to insure a 
good flushing at each rain-fall. 

As waste pipes always contain more or less foul air, 
which should be diluted and rendered as harmless as 



140 DRAINAGE. 

possible, a current of pure air must be admitted into 
them. This is accomplished by introducing at a point 
on the house side of the trap an air-inlet pipe, the full 
size of the drain pipe, and extending a foot or more 
above the ground. Through this pipe a current of air 
will now almost continually pass towards the warmer 
atmosphere of the house, except when a discharge takes 
place through the soil pipe. At such times the current 
of air may be for a short period reversed, and forced 
out of the vent pipe. As long, however, as such inlet 
is judiciously located, removed from windows, piazzas, 
or the cold-air box of the heating apparatus, a reversed 
current is not productive of harm. 

Several modifications of this plan have been devised, 
but all are based upon the above principle. 

If the grounds about the house are restricted in the 
direction of the sewer, this vent pipe may be carried 
to a point of the drain inside the house, leaving room 
outside for the rain-water spout to discharge into the 
trap. But, as has been said before, in no case should 
this spout be allowed to serve as the sole vent. 

A house drain, which has been properly constructed, 
does not require a catch basin ; but if, from lack of a 
sufficient fall or from being too large, or from any other 
cause, the flow through it is sluggish and stagnant, then 
an opening in the line of the drain is advisable, through 
which it can be cleansed by wires or scoops, or by 
flushing. 

Having now inspected the drain as far as the house, 
let us follow it into the cellar, — a portion of the dwell- 
ing which is too often found, both in the country and 
in the city, to be in a grossly unsanitary condition. If 



DRAINAGE. 141 

the drainage system has been properly constructed, we 
shall see in the cellar the continuation of the house 
drain, now made of iron pipe (this material is carried 
well outside the foundation walls), painted white to 
show any traces of leakage, and either running along 
the foundation wall or suspended from the ceiling, or, 
as some advocate, supported on brick piers built from 
the floor. 

In cases where it can be so arranged, it is a better 
plan not to allow the drain to traverse the house, but, 
following the sanitary rule, to conduct it outside as 
soon as practicable. With the drain constructed in the 
manner described above, it is brought into sight for 
inspection, — it being a well-recognized principle in 
modern house drainage, that as little as possible of this 
system should be concealed from view. 

In some houses, which contain plumbing fixtures in 
the cellar, the drain, made of earthen ware, is found 
buried beneath the floor. This is wrong, even when 
the vitrified pipes are used, since, as Mr. Gerhard says, 
they often crack through settlement, and have leaky 
joints, — the ground under the cellar thereby becoming 
saturated with sewage. Besides, it is impossible to 
properly connect an upright soil pipe to an earthen 
drain, for, no matter how well the joint between them 
is cemented, a settlement of the soil pipe will break off 
the hub of the earthen pipe, or the latter will settle 
away from the former, leaving an opening, through 
which the filth will escape. Such accidents are ex- 
ceedingly dangerous to health, as is instanced by the 
following illustration : — 

The family of a gentleman, living in one of our large 



142 DRAINAGE. 

cities, was stricken with diphtheria. Careful inspection 
disclosed a small crack in his cellar wall, while further 
investigation revealed a missed connection between an 
upright soil pipe and an earthen drain in the house of 
his neighbor, whose family was also suffering from 
diphtheria. The filthy contents of the pipe were pour- 
ing out just at a point where the gas and disease germs 
could pass, without check, through the crack in his 
wall. 

If the drain must be laid beneath the cellar floor, it 
should be of heavy iron, and be made accessible, so that 
any obstructions which may occur in it can be readily 
removed. 

In advocating that the drain pipe should be run 
across the cellar in plain view, I am reminded by the 
defects in some houses to suggest, that it should not be 
located in close proximity to the cold-air box of the 
heating apparatus ; since this box is very often leaky, 
owing to imperfect construction, and hence any flaw or 
leak in the drain pipe would cause the gases from it to 
be drawn into the furnace, to be distributed throughout 
the rooms above. 

It would seem almost absurd to remind you, that a 
refrigerator or an ice-box should not be directly con- 
nected with the drain by a pipe, to carry off the water 
from the melted ice, were it not that it is a custom 
which is not at all uncommon. Such a sanitary mistake 
was supposed to have brought severe sickness and death 
into the family of one of our most prominent citizens, — 
the articles in the refrigerator being actually tainted by 
sewer emanations. 

Having now hastily inspected the cellar, for time for- 



DRAINAGE. 143 

bids any reference to the subsoil drainage of it, let ns 
follow the course of the drain or, as it is now called, 
the soil pipe, upwards. We find it constructed of iron, 
usually four inches in diameter (it may be in small 
houses three and one-half inches, but never larger than 
four inches), jointed in lengths, and receiving waste 
branches from the various fixtures, such as bath and 
laundry tubs (the latter, however, sometimes connect 
directly with the drain), wash-stands, sinks, water closets, 
etc., — all of which constitute the internal drainage 
system of the house. This system is, as you can well 
believe, of vital importance, since by it the interior of 
our dwellings is brought into direct connection with 
the drains and sewers, from which sewer-gas will pene- 
trate into our living rooms, unless the house drainage 
is scientifically and thoroughly constructed. How infre- 
quently the proper attention is paid to this, even by 
those who ought to understand the system, the occur- 
rence of death, due to errors of construction, and the 
necessity for controlling the plumbing of dwellhigs by 
ordinance sufficiently attest. 

A former Lord Mayor of London, a gentleman well 
known for his researches into sanitary science, lost, some 
years ago, eight members of his family from diphtheria, — 
"a penalty I paid," he said, "for being a wealthy man, 
and having in my house all the modern conveniences, 
which, when too late, I discovered were defective." 

Under such circumstances, what should be a blessing 
proves to be a curse, and hence it would be far better 
to return to the old system, by which, at least, the germs 
of disease could not so readily be introduced into our 
houses to poison its inmates. This is a matter which 



144 DRAINAGE. 

concerns not alone those who are experts m all the details 
of house construction, but the householder also. Each 
individual is interested in it, independently of his neigh- 
bor and independently of the sewers, since no amount 
of skill nor care, in constructing these sewers, will relieve 
him of the necessity of using the same care and skill in 
building his house drains, particularly as these drains will 
often cause, by their faulty construction, more trouble 
than all the rest of the sewerage system. 

.One of the most common defects, found in the plumb- 
ing of the house, is the almost criminal carelessness with 
which the sections of the soil pipe are jointed, especially 
when these pipes are built into the wall, where any 
errors of construction can be effectually concealed. 
Such joints are often made with paper covered with 
sand, cheap mortar, putty, or red lead, which, it is need- 
less to add, will not prevent the escape of the gases from 
the pipe into the house. It is just in connection with 
these defective joints, that the advantage of the pepper- 
mint test, which is undoubtedly familiar to you all, is 
seen. As valuable, however, as this test is in its proper 
sphere, it is a fallacy to rely upon it, as many seem to 
do, to detect all the errors and defects in the house 
drainage. If too much reliance is placed upon it, it will 
prove to be a very unreliable agent. 

In order to carry out fully the principles of ventila- 
tion, the soil pipe should be extended above the roof 
not less than two feet, in order that its opening, which 
should never he obstructed by a hood nor return bend, 
may be well exposed to the air currents. This exten- 
sion should be at least the full size of the pipe, to insure 
an upward current, and to prevent its end becoming closed 
by hoar frost. 



DRAINAGE. 145 

Great care should be taken that these pipes do not 
terminate near windows, skylights, nor chimney tops, 
throngh either of which the escaping gas may be con- 
ducted into the apartments. For the same reason they 
should not open into chimneys, as some propose, although 
it is an excellent plan to lead them along a heated flue, 
in order to insure an upward draft through them. 

The necessity, which exists for ventilating the system 
in this manner, is derived from the fact that gases are 
generated in the soil pipe and drain from the decom- 
posing matters, which will inevitably coat their sides, 
and that consequently a ready method of escape must 
be provided for them. If this channel of outlet is not 
an open vent, such as the soil pipe extended above the 
roof, it will certainly be found through the branches of 
the soil pipe, extending to the various fixtures inside 
the house. 

All these attempts, however, at establishing an air 
current will be futile, unless the pure-air inlet, which 
has already been described, is furnished at a point out- 
side the house. Together with this inlet, the inner 
house drain and the soil pipe form a connecting system, 
resembling a syphon, through wliich there will be a free 
circulation of air, almost constantly in the direction of 
the warmer leg, — which leg, being inside the house, 
must be the soil pipe. Thus, with pure air steadily 
sweeping through the pipes in one direction, to dilute 
the foul air which they contain, and with water flowing 
in the opposite direction, to rapidly carry off the decom- 
posable materials which are poured into them, we have 
brought to our aid two very efficient agents in rendering 
modern drainage as harmless as possible. 



146 DEAINAGE. 

In this connection, it is proper to state that the air- 
inlet pipe is sometimes extended above the roof. This 
method, however, is open to the objection that the pres- 
sure of air would then be nearly equal in both legs of 
the syphon, and hence but little circulation of it ob- 
tained. 

As clear as this principle of ventilation would seem 
to be, yet there are many houses in every large city, in 
which the soil pipes have no circulation of air through 
them, but stop at the trap of the highest water closet, 
or with a closed end in the attic. That evil may result 
from such unsanitary plumbing, the following case will 
demonstrate : The occurrence of sickness and death 
in a house, situated upon one of the most fashionable 
streets in New York, led to a careful inspection of its 
drainage system, when it was discovered that the soil 
pipe, which received the wastes from all the fixtures in 
the house, terminated in the third story, where it was 
plugged with an iron cap. Inserted through this cap 
was an inch pipe, which ran to the tank, from which the 
whole supply of water for drinking and cooking was 
derived. It was thus intended to act as a waste pipe 
for the overflow of the tank, but in reality it served as 
an escape for the poisonous gases from the soil pipe, 
which by its aid found an entrance into the water des- 
tined for domestic use. 

We have now considered the proper method of venti- 
lating the house drainage ; viz., by extending the soil 
pipe above the roof, and providing an inlet for the 
admission of fresh air. The system is, however, incom- 
plete, since we have no reason to expect that the sewer 
air will seek an outlet through the soil pipe, in prefer- 



DRAINAGE. 147 

ence to the wastes which lead from the various fixtures. 
On the contrary, there is every probability that the 
gases will, on account of the warmer atmosphere of the 
rooms, be drawn into them through the different plumb- 
ing appliances with which they are furnished. Hence, 
some barrier must be placed in the line of all discharge 
pipes, which, by rendering it difficult for the foul air to 
pass, will cause it to escape through the unobstructed 
channel of the soil pipe. In other words, these discharge 
pipes must be trapped. The house drain has already 
been trapped, to prevent the escape inwards of the gas 
from the sewer, but in addition to this, each water closet, 
slop sink, wash bowl, bath tub, sink and set of laundry 
tubs should be provided with a reliable trap, placed as 
near to the fixture as possible. 

In considering the best form of trap for fixtures, it is 
needless to enter into the details of the many varieties 
which have been placed upon the market. All that it 
is necessary to remember, in selecting a trap for such 
purposes, is that the best is one, which will allow the 
water in it " to be entirely changed every time a good 
flush of water is sent into it." Hence, for reasons 
which have already been stated, the S trap seems for 
general use inside the house to be again the most 
desirable. 

Although the above rule applies to all traps, whether 
in a drain or under fixtures, yet it is particularly appli- 
cable to those for slop sinks, water closets and other 
fittings of a similar nature. In order that such fittings 
should be able to keep their traps in a proper sanitary 
condition, it is very necessary that they should receive 
their water supply for flushing from special tanks or 



148 DEAINAGE, 

cisterns. This safeguard is too often neglected in 
school houses and public buildings, in so many of which 
the flush of water is supplied in a feeble stream, which 
even then is only turned on at certain periods. The 
great defect in the water supply for such fixtures is the 
dependence upon a branch from the main water pipe in 
the house, from which pipe the drinking-water and that 
used for cooking is drawn. This is highly objection- 
able, since the supply is sometimes cut off on account 
of repairs in the street or in the house pipes, or when 
water is drawn from a faucet down stairs, thus leaving 
the fixture for a time without proper means for flush- 
ing. Moreover, under such circumstances there is dan- 
ger that the foul air, which is present in the interior of 
many closets, particularly the old-fashioned variety, will 
be sucked in by the vacuum produced in the pipe, and 
consequently contaminate the water. 

The dangers from this source are by no means hypo- 
thetical, but have been proved by well authenticated 
facts. One, which is often quoted, is the instance of a 
severe epidemic of typhoid fever, which broke out a 
few years ago in Caius College, Cambridge (England), 
where the most thorough, and, as was thought, the most 
perfect system of water supply and drainage had been 
introduced. Upon investigation it was found that the 
drinking-water had been polluted in precisely the same 
manner, as has just been mentioned. The whole diffi- 
culty was caused by a valve, which guarded the outlet 
of the branch pipe, having been placed horizontally 
instead of vertically, to be influenced by gravity, and 
thus permitted the escape of foul vapors into the main 
water supply. This case is interesting also, as showing 



DRAINAGE. 149 

from what trifling causes sometimes the most serious 
results will follow, and how careful workmen should be 
to perform their work in a proper manner. 

The best material for water-closet traps is earthen- 
ware or porcelain, on account of its greater cleanliness. 
Such traps are always placed above the floor, which 
brings them into plain sight, and makes them easy of 
access. 

While discussing the subject of traps, I cannot forego 
the opportunity of warning you against one variety, 
which has been extensively used for kitchen sinks. I 
refer to the so-called bell trap, which is worse than use- 
less, since it contains far too little water to effect a seal, 
and cannot be kept clean. If it is provided with a 
strainer, as it usually is, this strainer soon gets choked 
with the refuse of the sink, and is consequently removed, 
thereby leaving a direct communication between the 
drain and the room in which the sink is located. 

As valuable as tra2:)S are for the protection of dwell- 
ings against the entrance into them of sewer gas, their 
efficiency is somewhat impared by the fact that, under 
certain conditions, they may lose the water upon which 
they depend for a seal. This accident is likely to occur 
from the friction produced by a rush of water through 
them ; from syphonage, whenever a sudden flow takes 
place down the soil pipe into which the wastes discharge, 
or from another fixture connected with the same waste 
pipe — a partial vacuum thus being formed — or by evap- 
oration. The latter cause operates more frequently, when 
the water in the trap is not renewed by frequent use. 

Moreover, traps may be forced by the compression of 
the air within the sewers, when no proper vents have 



150 • DRAINAGE. 

been provided for their escape, or their water may absorb 
gases, giving them off on the house side of the trap, 
and even germs of disease, when the water is violently 
agitated. It is a very common belief that no gas 
can be transmitted through the water of a trap. As a 
proof, however, of the facility with which this can be 
accomplished, it is only necessary to suspend a piece of 
litmus paper, saturated with a solution of sulphate of 
lead, over any unventilated, but trapped pipe, leading 
to a drain, and notice how quickly the paper will 
become blackened by the action of the gas. Dr. 
Fergus, of Glasgow, found that ammonia would pass 
through the water of a trap, which he had made from 
glass for the sake of experiment, and bleach litmus 
paper in fifteen minutes, and that sulphurous acid, sul- 
phureted hydrogen, carbonic acid, hydrogen and chlorine 
would produce their chemical effects in from one to two 
hours. 

For the reasons, which have just been described, 
mechanical traps were invented — most of which, how- 
ever, on account of their complicated parts, and the 
difficulty of keeping them clean, are unserviceable. 
One of the best of them, in my estimation, is a modi- 
fication of the so-called Bower trap, which, on account 
of its simplicity, may be used with advantage under 
wash bowls and other fixtures of a similar nature, from 
which the discharge of water is reasonably clean. 

Most, if not all, of the dangers arising from traps, 
may be reduced to a minimum by a thorough ventila- 
tion of the sewerage and drainage systems, and by 
leading each discharge pipe separately into the soil pipe. 
This latter plan is not, however, always practical in 



DRAINAGE, 151 

large buildings. In addition to these safeguards, very 
thorough protection against syphonage, back pressure 
and absorption of gases is afforded by attaching a vent 
pipe to the upper bend of each trap, and leading its 
open end through the roof to the outer air. These 
vents may be collected into one common branch, opening 
into the soil pipe above the highest fixture. An ad- 
ditional advantage, which these vents possess, is that 
they serve as a channel for the escape of the foul air 
which is generated in the waste pipes, and hence add 
very greatly to the completeness of the ventilation. 

Objection has been raised to such vents by some 
writers, that they greatly increase the cost of plumbing, 
especially where the fixtures are scattered throughout 
the house; that they tend in some degree to increase 
the evaporation of water in the traps; and that they may 
become clogged by the splashings of soapy water. In 
view, therefore, of the difference of opinion which ex- 
ists in regard to their necessity, it is suggested by Mr. 
Gerhard that a middle course be pursued, and that, 
where fixtures are located some distance from the soil 
pipe, into which they consequently discharge through a 
long waste pipe, it is positively necessary to provide 
those vents. If, however, the fittings are located quite 
near a vertical, thoroughly ventilated soil pipe, or a w^ell 
ventilated horizontal pipe, they may be dispensed with, 
provided a non-syphoning trap is used. 

In connection with this subject, there are several fix- 
tures in almost every house, which demand particular 
consideration. The most important of these is the 
water closet, — a proper selection of which is rendered 
very difficult, on account of the many varieties which 



152 DRAINAGE. 

are offered for sale. Without discussing the advantages 
or disadvantages of all of them, it will be sufficient to 
state generally that water closets are divided into two 
classes ; viz., those which are provided with mechanical 
parts, and those which consist of a plain bowl, usuallj'' of 
earthenware, with the whole flushing machinery located 
in a special tank. To the former class belong the pan, 
valve, and plunger closets, and to the latter the hopper 
closet, which is again divided into the long and the 
short forms. 

Of all the different varieties, the pan closet, which is 
the one most commonly used, is the worst. Tightly 
encased in wood-work, there can be no ventilation of 
the space under the seat; it usually receives its water 
supply directly from the main water pipe of the house ; 
its bowl is with the greatest difficulty kept clean ; its 
receiver, which is made of iron, and rough on its interior 
surface, soon becomes fouled by accumulated deposits, 
which the water flush cannot remove ; while every time 
the pan is tilted the generated gases are forced into the 
room. Add to these defects, the facts that the trap will 
usually become coated with filth and give off foul vapors 
to increase the volume of those already collected in the 
receiver; that the various apertures outside the bowl 
furnish a direct communication between the interior of 
the wooden casing and the soil pipe; that the gearing, 
with which the closet is provided, is invariably loose and 
easily deranged; that the pan becomes quickly corroded 
by the action of the sewer-gas, thus depriving it of one 
of its seals, and we have the very quintescence of an 
unsanitary fixture. 

The valve and the plunger closets, although somewhat 



DRAINAGE. 163 

superior to the pan variety, become readily fouled, and 
their complicated machinery is very liable to get out of 
order. 

The best closet is undoubtedly the hopper closet, on 
account of its extreme simplicity and the great force of 
its flush — the water being supplied through a large 
pipe leading to a special tank. Of the hopper variety 
the short one is the most desirable, since it presents 
less surface for fouling, and the trap is located in plain 
sight above the floor. Again, preference should be given 
to the modification of this closet, known as the " wash- 
out," which is made of earthenware, in one piece, and 
the basin so shaped that it holds water, and forms a trap 
against the escape of gases. 

Whatever form is used, however, care should be taken 
that the closet is placed as far as possible from the living 
rooms ; and, wherever located, strict attention should be 
given to the ventilation of the room in which it is situ- 
ated, by a window opening from the top. This precau- 
tion is often almost entirely neglected, — the closet, 
particularly the servants', being tucked away in a dark, 
oftentimes damp, corner (the very soil in which disease 
germs retain their vitality), with no chance for the 
sewer gas, which emanates from it, to escape, excepting 
into the house. This defect is not uncommon in school 
houses. 

The only remaining fixtures necessary to be men- 
tioned are the wash bowls and bath tubs, which 
are so often improperly designed and constructed. 
Their wastes frequently lead directly into the soil 
pipe, with no trap to break the connection, or if trapped, 
it is only by running these wastes into the water-closet 



154 DRAINAGE. 

trap below the water line. Further, the overflow pipes 
are often conducted into the discharge pipes of the fix- 
tures beyond the trap, thus affording an easy passage 
for tlie escape of the gases into the apartment. 

If it is certain that tlie sewers and drains have been 
j)roperly constructed, and that the plumbing of the 
house is in a perfect condition, there can be no objec- 
tion to placing a fixed wash-stand in a sleeping apart- 
ment ; yet, with the doubt which must so often exist 
upon these points, it will be safer to depend upon the 
bowl and pitcher in this important room. 

Whatever the fixture may be, — wash bowl, bath tub, 
water closet, etc., — the best modern plumbing leaves 
them all without any casing or covering. Pipes may 
not look quite so well as handsome cabinet work, but it 
is a sanitary measure to uncover them, since cleansing 
is thereby greatly facilitated, and everything is brought 
into plain sight for inspection. 

In contemplating this whole subject, I wish to im- 
press upon you that its importance cannot be over esti- 
mated, and that no matter from what standpoint we 
look upon it, — whether from a consideration of the evils 
arising from lack of sewerage, or from imperfections in 
a system already existing, — it demands the closest atten- 
tion. The relation between filth, which improper sew- 
erage creates, and disease has been abundantly proved 
by exjDerience, — particularly in cities, where large 
masses of people are crowded together, and where, if an 
epidemic of any disease breaks out, it tends to run a 
more rapid and fatal course. This is especially true in 
the case of children, whose delicate organizations sub- 
ject them, if not to a more ready inception of the 



DRAINAGE. 155 

poisons of disease, yet certainly to more rapid deteriora- 
tion of health, when ^hey are exposed to unhealthy 
surroundings. 

It is to aid you in detecting the defects in what may 
be either your master or your slave, according to its 
condition, that I have in this necessarily imperfect 
manner brought the subject of drainage before you. In 
remembering the details of it, I trust that you will also 
remember that eternal vigilance is the price of health, 
and that, having fitted your houses with perfect 
drainage and plumbing, it all needs looking after 
from time to time, just as much as any machinery 
or engineering structure. Recollect also that, although 
good plumbing is expensive, yet, to take the lowest 
view of it, sickness and death are more so still. 

In bringing to your notice, however, what may be 
justly termed "filth in its relation to disease," it has 
been far from my intention to overdraw the picture, or 
to assert that our surroundings are in an altogether 
unsanitary condition. The records of mortality prove 
the contrary ; but that this mortalit}'- can be still 
further decreased, I have not the slightest doubt, 
if individuals would but recognize what is meant 
by filth and the effects produced by it, and not 
delude themselves with the belief that, because 
their surroundings seem healthy; that, because their 
houses are provided with every modern luxury, no filth 
exists about them. 

This assumption of cleanliness is often made by in- 
dividuals, either through ignorance of the sources of 
filth, or from the natural reluctance, which every one 



156 DRAINAGE. 

feels, to acknowledge even to himself, that his house or 
his premises are in an unsanitary condition. Possibly, 
however, with the best intentioned desire to detect a 
supposed sanitary error, it may be hastily assumed that 
no such error exists, because it may not have been im- 
mediately discovered. But, as has been already pointed 
out, because filth is not suspected, it does not prove 
that it does not exist: it may lurk in the drinking- 
water, which is not condemned, because it has neither 
an offensive odor nor an unpleasant taste, or because 
the microscope has failed to detect in it the germs of 
disease ; or it may be present in the gases of decomposi- 
tion, which are not recognized, because they may not 
give out a sickening smell. The source of filth may not 
be evident to the sight : it may not be the pig-sty, the 
manure or compost heap, the privy, the cesspool, or the 
slop water, from which the wind blows the emanations 
into the house ; but it may be a pile of decaying pota- 
toes, which, buried under the kindling-wood, has not 
been suspected, but which none the less surely caused 
an outbreak of tj^phoid fever in the house of a western 
physician ; it may be the sudden filling of the sewer 
with rain water, which has compressed the sewer-gas 
through unguarded inlets into the sleeping room ; it 
may be a leaking soil pipe in the wall, such as produced 
erysipelas in Middlesex Hospital ; the cesspool gas, 
which has been conveyed by the cold-air box, through 
the furnace, to our living rooms ; the minute defect in 
a water-closet valve being placed horizontally instead of 
vertically, such as caused the outbreak of typhoid fever 
in Caius College ; it may be in the ice, such as caused 



DRAINAGE. 157 

intestinal disorders at Rye Beach ; in the milk, such as 
has produced so many outbreaks of typhoid fever in 
England ; or it may be that the cause exists "in houses 
built on hills, in which the most skilful engineers and 
architects have exhausted, as they believed, the re- 
sources of modern science, from the sewer-gas which 
has ascended by its lightness through drains having a 
rapid fall." 

Moreover, filth does not always operate where it 
stands. It may not be on the premises where disease 
has broken out : it may exist on those of a neighbor, 
in a broken soil pipe, which was supposed to have 
caused diphtheria to attack a wealthy family in New 
York ; it may be that a neighbor's filth has leached into 
our well ; that from his cesspool, his slop water or his 
defective drain, sewer-gas has escaped into our house ; 
or it may be that the ventilation of the main sewer by 
rain-water spouts has produced disease, as it did so 
markedly in Croydon. 

But filtli may not advance upon us from the next lot ; 
it may invade our houses from long distances off, to 
cause disease, as was the case last winter, when 'an 
epidemic of typhoid fever broke out in a Pennsylvania 
town, from the pollution of a stream at its head, several 
miles distant ; or, when the same disease almost devas- 
tated certain portions of a town in IMassachusetts, the 
germs being wafted from a school house in which an 
epidemic of it had occurred. 

Country districts prove no exception to the rule. 
Because an epidemic breaks out in the country it is 
unwarrantable to assume that filth has nothing to do 



158 DEAINAGE. 

with its causation, simply because it has occurred in the 
country. The sanitary condition of many rural dis- 
tricts is notoriously bad, and in them, therefore, epidemics 
often rage with great intensity and fatality. But it is 
because they are cursed by an entire lack of drainage, 
with slop waters, privies and cesspools polluting the 
ground, well water and springs, as well as the atmos- 
phere ; because the members of the household fre- 
quently occupy, as a living room, one upon the ground 
floor, in close proximity to the source of the gases 
which float in at the open window ; or because the soil 
is damp, thereby producing malaria, consumption and 
diphtheria. 

A great responsibility, therefore, rests with those, 
who hastily assume that no unsanitary condition exists, 
to cause the many diseases which are now recognized 
as ill a measure preventable, — an assumption which 
too often induces a false sense of security, from which 
they may be roughly awakened by the presence of 
death. There has never been a time when physicians 
were more thoroughly convinced, that great care should 
be 'taken in pronouncing too hastily against the existence 
of a definite cause for certain diseases, since the opinion 
is growing, that filth prevails as an originator of sick- 
ness much more frequently than is even suspected. 

Communities and individuals are easily aroused to 
the realization of these principles and of their own 
danger, in the presence of severe epidemics, but like 
the horrors of an Ashtabula railroad accident, or the 
City of Columbus marine disaster, the lessons to be 
learned from these outbreaks of disease are soon forgot- 



DRAINAGE. 159 

ten. If this should occur at the present time — if we 
should consign to the dim memories of the past all 
recollection of our ability to stamp out certain diseases 
— we must be held accountable. Is it not better, there- 
fore, to heed the hand-writing on the wall, and, by- 
following the old Greek sanitarian's maxim of pure 
air, pure soil, and pure water, to prevent, as far as lies 
in our power, the possibility of threatened epidemics ? 



THE KELATION OF OUR PUBLIC SCHOOLS TO THE 
DISORDEES OF THJl NERVOUS SYSTEM. 

/ 

By C. F. FOLSOM, M.D., 

Physician to Out-Patients with Diseases op the Nervous Ststem, 
Boston City Hospital. 



A LIBERAL education in the sense in which the 
-^--^ term was used when the Boston public school sys- 
tem was begun, is no longer possible. In the place of 
knowing everthing worth knowing in his day, as was 
said of Lord Bacon, the most highly educated man of 
the present time does not know the whole of his own 
profession. The occupations of mankind have become 
so enormously diversified that no school can fit its 
pupils directly for any considerable number of them ; 
so that general training, rather than the acquirement of 
learning, has become more and more the purpose of our 
best systems of public education. Committing to mem- 
ory page after page of an increasing variety of text- 
books, largely for the sake of brilliant competitive 
examinations, beside overtaxing the brain, has been 
proved to be, as a means of educating children, far infe- 
rior to methods by which the observation, reflection, 
and judgment are trained. When the youth of either 
sex leaves school to seek a place in the busy world, the 
question asked him or her is " What can you do, how 
well can you do it, and how will your strength hold 



162 DISOEDEBS OF THE NEEVOUS SYSTEM. 

out ? " not " What do you know, can you spell words 
that would puzzle a lexicographer, or do suras, as it is 
called, beyond the powers of a bank cashier?" 

As a consequence, the courses of study which best 
develop the mind and best prepare the pupil for the 
duties of life, and also least injure the physical health, 
are gradually taking the place of those which most dis- 
regard the welfare of the body and the mind. I doubt 
very much whether the great change which has quietly 
taken place in this respect in our Boston schools, more 
especially in the last few years, including the addition 
of manual and industrial education and object teaching, 
is at all appreciated by the community, or fully under- 
stood by those who most criticise our public school 
system. 

There is another much more important change which 
has been slowly going on for several generations, and 
more rapidly during the last quarter of a century, 
which should be taken into full consideration at the 
beginning of our inquiry into the question of the rela- 
tion of our public schools to disorders of the nervous 
system, namely, a change in the mental and physical 
type of the race. For fifty years or more, the fact has 
been observed and remarked upon in this country, often 
in exaggerated terms, that the Anglo-American has 
become taller and thinner, with less appearance of 
robust physical health, with a more sensitive nervous 
organization, and with an increased intolerance of stim- 
ulants of all kinds. 

At a recent meeting of the British Association for the 
Advancement of Science in Bristol, it was generally 
agreed by the large number of members of the associa- 



DISORDERS OF THE NERVOUS SYSTEM. 163 

tion who took part in the discussion, that a similar 
change was taking place in England, — that the John 
Bull of Nelson's time is not the Englishman of to-day. 
The same tendency has also been noted in Germany. 

In a general way, it may be said that with some mod- 
ifications due to climatic and social influences, this 
development of the nervous type of character bears a 
direct relation to the intellectual and industrial growth 
of the people. It is more marked in the United States 
than in Europe, and much more pronounced in Massa- 
chusetts than in any other part of our country. We 
see more of it, living in a land of such mental activity 
that twenty thousand patents are granted each year, in 
a state where there is a school to each three hundred of 
the population, and in a city whose public library is 
more consulted than the British Museum in London, a 
city of ten times the size of Boston. 

The enormous increase in the popular knowledge of 
a few of the laws of health, the immense growth in 
Avealth in all parts of the world, and the vast spread of 
the principles of humanity and philanthropy in dealing 
with those portions of society who are unable to protect 
and provide for themselves, have resulted in such an 
improvement in the sanitary conditions of our towns 
that the pestilential diseases are fast disappearing. 
There is, also, an immediate diminution in the mortality 
from all filth diseases, and a decrease in the average 
death-rate, with a proportionate saving of life. 

Now those diseases which are chiefly affected when 
death-rates are lowered by a wise enforcement of the 
principles which lie at the foundation of an improved 
public health, are diarrhoeal diseases and infection 



164 DISOEDERS OF THE NERVOUS SYSTEM. 

diseases, which cause by far the greatest number of 
deaths in children under five years of age ; typhoid 
fever from which about one-half of the deaths occur in 
or before early manhood and womanhood ; and pulmo- 
nary consumption, a disease in which nearly forty per 
cent of the mortality falls upon persons between the 
ages of fifteen and thirty. But just as many people must 
die, and if more individuals live, by reason of our 
improved methods of living, beyond infancy and the 
early ages of life, just so many more will die of old age 
and the diseases peculiar to older people, and the death- 
rates will in time be equalized. That is to say, our 
efforts to improve the welfare of the human race have 
diminished the sources of death from one set of causes, 
and have proportionately increased them from another 
series of causes. If a person's chances of death from 
cholera infantum and typhoid fever are diminished, 
there is, of course, greater probability of his living to 
the full term of life until death by old age, but at the same 
time there are more chances of his becoming a nervous 
invalid, or dying with apoplexy. It is easy to see, there- 
fore, that with fewer deaths from the plague, cholera, 
diarrhoeal diseases, scarlet fever, typhoid fever, pulmo- 
nary consumption, there will also be a higher mortality 
from Bright's disease, apoplexy, paralysis, cancer, and 
those diseases of the brain and nervous system which 
are common to the later years of life. In other words, 
simply from our better habits of living, our increased 
cleanliness, our purer water supplies, our expensive 
sewerage systems, there has been an increase in the pre- 
valence of diseases of the brain and nervous system 
independently of our schools, our factories, our libraries. 



DISORDERS OF THE NERVOUS SYSTEM. 165 

our churches, or entirely apart from those conditions 
and circumstances vvhicli are generally thought to give 
rise to nervous disorders. 

The enormous growth of charity and philanthropy 
tends also in the same direction, by saving thousands of 
infant lives; our hospitals send out to renewed life and 
activity many who would otherwise have soon become 
lielpless and died ; improved medical skill builds up the 
weak and trains the imbecile, while an almost hot-house 
heat of the modern furnace rears the delicate children, 
which a century ago would have been virtually frozen 
out of existence in the barn-like rooms of our great- 
grandfathers, in which the tender lives struggled for 
existence. The survival of the fittest is brought about 
to some extent by a somewhat different process of selec- 
tion from that which obtained a hundred years ago. 

This has its advantages and its disadvantages. The 
pestilence that carried away its millions in a single epi- 
demic not only took the weak and those unfit to sur- 
vive, but it atso, like the great fire consuming granite 
as well as pine, laid low the statesman and the great 
painter. The epidemic which killed its thousands of 
ill-favored, debilitated, and useless persons, hardly fit to 
live, also destroyed the most needed citizens. The in- 
humanity that let the children of the needy perish of 
neglect also failed to rescue, now and then, a genius or a 
great benefactor of mankind. 

In redeeming the plague spots of our cities from the 
dangers of pestilential diseases, we have, at the same time, 
protected the more favored portions. But, on the other 
liand, we have by that very means reared many feeble 
and diseased individuals who otherwise would have per- 



166 DISORDERS OF THE NERVOUS SYSTEM. 

ished. For this, society gets its compensation in saving 
many persons whose brilliant minds make them invalu- 
able to the world, in spite of their weak bodies, and in 
elevating its own moral standard. The fact is worth 
bearing in mind, though, that we thereby have more 
paralytics, more insane, and more persons of the neuro- 
pathic, or nervous, constitution, who react readily to 
external conditions unfavorable to health, and who 
easily became subject to the whole brood of nervous 
diseases. 

I think that I am right, too, in saying that the pre- 
vailing type of nervous diseases has changed. The dis- 
eases of the imagination, which are cured by appeals to 
educated or uneducated superstition, by arousing the 
will, by stimulating the imagination, are disappearing, 
and are replaced by diseases dependent upon distinct 
disorders of brain nutrition, or indicating organic 
changes in the central nervous system. This circum- 
stance shows both the high brain-tension of our age and 
the dangers of physical deterioration, two points of 
importance in our discussion of the school question. 

The whole tendency of modern life is to physical 
strain and brain-worry, which are aggravated by a resort 
to all sorts of artificial stimulants; and, last of all be- 
wildering devices, comes the telephone, to annihilate 
time and space. The very necessities of our civilization 
compel a high degree of activity and a high standard of 
accomplishment in some direction, with all the emo- 
tional strain of eager striving for success, or of repeated 
failure and disappointment. Our narrow streets and 
high buildings keep out the sunshine ; our big cities 
devitalize the air, and bad sanitary arrangements in 



DISOKDERS OF THE NEHVOUS SYSTEM. 167 

most of our schools and houses make it still worse. 
The necessities of daily bread and butter drive children 
at an earlier age into occupations injurious to health. 

In a recent number of the Boston Medical and Surgi- 
cal Journal, there is quoted a lecture at the- Parkes 
Museum of Hygiene in London, by Mr. James Cantlie, 
who says that it is impossible to find a pure Londoner 
of the third generation ; that is to say, an individual 
whose two parents and four grandparents were all born 
and bred and continuously dwelt in London. It is rare 
to find an individual whose two parents and three out 
of four grandparents fulfil the above condition ; and 
such an individual is a very miserable, ill-developed 
specimen of the human race, of stunted growth, low 
stature, small head, and feeble intellect, destitute of any 
faculty of enthusiasm or humor, and very liable to scrof- 
ulous disease. England, Mr. Cantlie tells us, is con- 
stantly pouring into London a stream of healthy folk, 
whose offspring degenerate, so that the race quickly 
ceases to be. The upper middle classes, the professional 
classes, who take a long annual holiday, and whose chil- 
dren are generally educated at public schools in the 
country, are, of course, to be excluded from this gener- 
alization. 

A similar evil exists, more or less, in all great cities 
and large manufacturing towns, suggesting one of the 
most perplexing problems with which we have to deal, 
namelj^ the degeneration of the human race in crowded 
places, and what means we can take to counteract it. 
Do our schools help or hinder in this gigantic under- 
taking? 

In the boys and girls of to-day we not only have a 



168 DISORDERS OF THE NERVOUS SYSTEM. 

more complex, delicate, sensitive organization to deal 
with, as compared with a century ago, but we have cre- 
ated a set of external conditions for them to live in, 
which is full of influences calculated to injure even a 
strong nervous constitution, much more a weak one. 

That the difficulty of which I speak is a serious one, 
demanding our most earnest attention, no thoughtful 
person will deny. There are two ways of meeting it. 
The first will not find favor with any of us here. It 
consists in shielding the child or youth from every trial, 
and in carrying him over every hard place; in making 
everything easy for him, on the ground that he is not 
yet strong enough for the fight. The second foresees 
the struggles of life, and prepares the tender child, even, 
for them, by strengthening him in every possible way 
to meet and conquer them rather than evade them; at 
least, to carry life's successes with steadiness, or bear its 
reverses with equanimity. 

The influence of our schools in producing this more 
nervous type of character, with an increased amount of 
diseases and disorders of the nervous system, and the 
present tendency of our methods of education in that 
regard, how far they add to the nervous debility or 
strengthen for the contests of life, are questions easy to 
ask, but, in my opinion, much less easy to answer. It is 
a problem which must be studied, not only in the class- 
room but also p-H'the-street, in the homes, at the theatre, 
in the dispensary-district, among the hospital out- 
patients, in the sick wards, behind the shop counters, 
among the factory looms. The question is often de- 
cided, I find, upon the evidence of a single case, or of 
two or three cases, and not seldom without sufficient 



DISORDERS OF THE NERVOUS SYSTEM. 169 

weight being given to all the possible explanations of 
the facts observed. For instance, a young man of 
twenty-two said that he graduated in his twelfth year, 
in a course of study usually finished at the age of six- 
teen, and that a few years later he became epileptic ; 
that he had studied out of school more than the other 
boys, but that he got ahead of them chiefly by his 
brightness. Over-pressure in the schools has created 
epilepsy, was the immediate verdict. In the first place, 
are the facts as stated entirely correct? Secondly, if 
there was over-pressure in school, whose fault was it 
that it was allowed? did the teachers encourage or 
stimulate it? did the teachers protest against it, and the 
parents allow it ? did the doctor advise against it, the 
teacliers point out its unwisdom, and yet the parents 
insist upon a homicidal course, as happens sometimes? 
Was the case an illustration of that marvellous com- 
pensation in nature for failure in one direction by con- 
centration of force in another, of which the epileptics 
Caesar and Napoleon were the most conspicuous exam- 
ples, or, finally, did the epilepsy arise from an accident, 
by a blow on the head, by a fall, or by a severe mental 
shock, — in conditions subsequent to the school-life or 
independent of it, an explanation rendered quite prob- 
able by the fact that an older brother did the same as 
the younger in school and is quite well. I am still 
seeking for the correct answer to these questions, with- 
out any expectation of ever finding it. 

To take another illustration, a young graduate of a 
high school and of a college for women breaks down 
with all the symptoms of the familiar name " nervous 
prostration," and is passed about from one doctor to 



170 DISOEDEES OF THE NERVOUS SYSTEM. 

another as an interesting example of the pernicious re- 
sults of the higher education of women, i^nother phy- 
sician sees her and thinks that he recognizes a certain 
physiognomy of disease with which he is familiar. 
After a study of the family history, as well as of the 
individual, he believes that there has been simply the 
evolution of a natural law of development in the case, 
and tliat a vicious constitution or a brain not entirely 
right at the start has not only not been injured by the 
mental training, but that it has been improved (and 
might have been improved more), that the breakdown 
is less disastrous than it Would have been but for the 
schools and college. One set of doctors concludes that 
women have too much of study ; another thinks that 
they have not enough or at least not of the right kind. 
Who shall decide? There certainly are not statistics 
available to settle the matter, if the}'" ever can be got, 
and then there would come the inquiry, how were the 
statistics prepared ? 

The literature of the subject is abundant, but much 
of it bears the marks of hasty generalization or of pre- 
judging the case. I will mention one recent report of 
this character, which has had great influence in London, 
because of the wide reputation of the author in another 
field of knowledge, but where the opinions advanced 
were confessedly formed before investigation, and where 
a statistical table of the prevalence of headache was 
soberly prepared and offered as scientific evidence, by 
asking those children to raise their hands who had 
headache in certain described localities. 

As regards the influence of our schools on the health 
of the community, as shown by an increased prevalence 



DISORDERS OF THE NERVOUS SYSTEM. 171 

of disorders of tlie nervous system, the question pre- 
sents itself to me in two different aspects: first, as affect- 
ing persons attending scliool; and secondly, in the effect 
of the school-training as manifested in later life. 

At the outset, it should be said that there are schools 
and schools, and that there are teachers and teachers. 
Even in Massachusetts, a State which seems to me, m 
respect of its schools, to be living on its past laurels, 
schools may be found in commendation of which I could 
have very little to say. There are others for which I 
should suggest hardly a single criticism. The fresh air, 
broad sunshine, and simple habits of country towns may 
compensate for much that is bad in methods and amount 
of study. The constant hurry and excitement of a 
crowded metropolis may render the adoption of the 
wisest system of education a matter of the greatest 
difficulty. It is utterly beyond the power of the most 
accomplished superintendent, the ablest and most pains- 
taking supervisors, the most conscientious teachers, to 
devise and carry out any plan of instruction which will 
wholly counteract the bad influence of conditions acting 
constantly and unfavorably upon the physical health of 
the pupils. The subject is a large one, and I shall en- 
deavor to stimulate thought and effort, rather than to 
solve a problem. What I shall have to say will apply 
to Boston schools, because my time for this discussion 
is limited, and because I have less exact information 
about other schools. It is offered simply for what it is 
worth, as the result of the observations and experience 
of one man. 

The task of the schools is no easy one. They must 
furnish a course of instruction flexible enough, not only 



172 DISOKDERS OF THE NERVOUS SYSTEM. 

to suit the brilliant, the clever, those of average or fair 
ability, and the dull or even stupid, but also to be 
adapted to the sound and the unsound, the vs^ell and the 
ill. Different grades of mental capacity may be readily 
accommodated by advancing certain pupils and putting 
back others. Different standards of soundness or health 
can be provided for at best only imperfectly except with 
the cooperation of parents. 

Among the conditions of departure from health, which 
one sees in the schools, the most important is the neurO' 
pathic, or nervous, constitution, existing in all degrees 
of intensity. In its pronounced form, it is closely allied 
to the well-marked functional diseases of the nervous 
system, and, at the critical periods of life, may readily 
develop into them. It is congenital, or due to early 
interference with the normal development of the brain 
by injury or disease, and it may be enormously aggra- 
vated from faulty training and bad habits of life. It 
shows itself in infancy and childhood by irregular or 
disturbed sleep, irritability, apprehension, strange ideas, 
great sensitiveness to external impressions, disagreeable 
dreams and visions, romancing, intense feeling, periodic 
headache, muscular twitchings, — conditions all of which, 
in my experience, have been attributed to the schools. 
There is often excessive shyness or bravado, introspec- 
tion and self-consciousness. The imitative and imag- 
inative faculties may be quick. The affections and 
emotions are strong. The natural feelings easily be- 
come disturbed and perverted. The passions are un- 
duly a force in the character which is commonly said 
to lack will-power. 

Self-discipline and self-control are acquired only with 



DISORDERS OF THE NERVOUS SYSTEM. 173 

great difficulty. The memory is now and then phe- 
nomenah There is a ready reaction to external circum- 
stances, even to the weather, by which the individual 
becomes easily a little exhilarated or somewhat de- 
pressed. They are apt to be egotistic, suspicious, and 
morbidly conscientious. Slight physical ailments, 
hardly noticed or rapidly recovered from in sound 
children, leave on them a long or lasting impression. 
They become neurasthenic, hypochondriacal, or nervous 
invalids, so called, and they break rules or disregard 
established customs with less cause or provocation 
than other persons. They lack stability, or have 
narrowed limitations of intellectual energy, in quality 
or quantity. 

To the nervous temperament belong social and 
intellectual gifts and graces, originality, intensity, 
poetry, art, philanthropy, without which we should 
be great losers. Within reasonable limits, the nervous 
temperament, if fairly well trained, is a great benefit to 
society and the world. Of its extreme development we 
have the most conspicuous examples in our great cities. 
We see many such children in our schools, and we 
must provide for them in the best manner possible. 
They need not only as much care as other children, 
but far more, as lack of proper training results more 
disastrously to them than to others. 

Next in importance come those children who have 
inherited weak bodies, or who have acquired ph^^sical 
weakness as a result of illness or injury ; those who 
are sent back to school — a very common fault — before 
the strength has been fairly regained after infectious 
and other diseases ; and finally, the large number who 



174 DISORDERS OF THE NERVOUS SYSTEM. 

suffer from disabling maladies of too obscure a character, 
or of too light a degree of severity, to be detected by 
the teacher or parent. Chorea, commonly called St. 
Vitus's dance, to mention a striking instance, is a 
general disease, associated with cerebral symptoms that 
are often overlooked, and with muscular twitchings 
which are unmistakable. It frequently occurs with 
sleeplessness, irritability, headache, inability to apply 
the mind, and slight loss of flesli, as the only noticeable 
symptoms. Sometimes the mother observes a simple 
change of character, that the youth becomes childish, 
the child babyish. In this stage or degree the case is 
quite likely to be thought one for discipline, whereas 
rest and medical treatment are indicated. Not seldom 
the parent, oftener the father than the mother, speaks of 
the idleness, stupidity, peevishness, obstinacy, untruth- 
fulness, want of aptitude and receptivity of a child 

— terms which to them have only a mental or a moral 
bearing, while the physician sees that they depend upon 
conditions of disease which have no ethical significa- 
tion whatever. 

In the city of Brussels — the only place, beside Paris, 
where there is thorough medical inspection of schools 

— it is claimed that by that means this large class of 
children receive proper care, and it is asserted that the 
same results cannot be got in any other way. Some of 
them must be taken from school altogether; others 
should remain in school only a part of the school 
hours, or do nothing some of the time, if it is best for 
them to stay in school to keep out of the street, and 
many get on by dropping some incompatible or em- 
barrassing branch or branches of study. The careful 



DISORDERS OF THE NERVOUS SYSTEM. 175 

oversight of many of our Boston teachers partly 
reaches this evil. It cannot be better illustrated than 
by reading a letter from one of them to a parent who, 
up to that time, had not observed anything wrong 
about her child. This girl came to the City Hospital 
a well-marked example of the neuropathic constitution, 
and at the time referred to had the mild form of chorea, 
for which she needed at least six months' careful atten- 
tion to her health. 

The letter is as follows : — 

Dear Mrs. : 



I am very sorry Mary is far from well. She was nervous enough 
before she was sick with her cold, but now she is so much worse. 
I think the best thing for Mary will be to leave school for a while 
and play out of doors. Keep her in the sunshine all you possibly 
can, and let her go out every day, no matter what the weather is. 
The close confinement of the school-room is very bad for any one 
so nervous. She was such a smart girl I am very soi-ry to have 
this happen. It is solely on her account that I recommend this 
measure, but I think you will find it will be for the best for her to 
drop all books for a while, and not study at all. 

You need not fear but what she will know enough and learn 
enough by and by. 

Perhaps if she could go away for a few days the change of air 
might help her. 

Of course you must do as you thmk best. 

Yours respectfully, 



Parents often bring their children to the hospital 
with just this sort of a statement, showing how careful 
of their pupil's health some of the teachers must be, to 
detect evidences of disease before even the mother's 
watchful eye sees them. 



176 DISOEDEES OF THE NEEVOTJS SYSTEM. 

The children of the well-marked neuropathic consti- 
tution not only cannot live at the higli pressure common 
to our age, nor even at a moderate pressure, but every- 
thing must be arranged for them on a low pressure 
scale. They are capable of only a limited amount of 
work, and easily break down if that limit is exceeded. 
It is simply impossible for them to go through the full 
routine of school work, and many of them, for that rea- 
son, drop out of the primary or grammar schools, with- 
out attempting the strain of the high schools; and yet 
they need such training as they are capable of even 
more than other children. 

This class of children, of all degrees of mental and 
physical limitations, together with those who are ill or 
not sufficiently recovered from acute diseases, we will 
pass over for the present, and consider the influence of 
the schools on children and youths of fair physical 
health and moderate mental brightness. 

It is not necessary, before this audience, to argue the 
value of physical health. If Mr. Mill insists that the 
man who aspires to be a teacher of his fellowmen must 
suffer from ill health, we simply answer that Mr. Mill 
would have taught more healthy doctrine, would have 
done more good, if he had not suffered so much from 
the headache and neuralgia and dyspepsia of overwork. 
Huxley's view is sounder, — that the successful men in 
life, in the long run, are those who have stored up such 
physical health in youth that they can, in an emergency, 
work sixteen hours a day without suffering from it. 

Do the children of the public schools come up to a 
reasonable standard of health? — I do not mean the 
high standard of Huxley. I think that they are far 



DISORDERS OF THE NERVOUS SYSTEM. 177 

below it. Pale faces, languid work, poor appetite, dis- 
turbed sleep, headache, and what is vaguely called ner- 
vousness, are more common among them than they 
should be among children of their ages. I doubt whether 
there is an exaggerated prevalence of manifest or well- 
marked diseases of the nervous system among them. If 
due to the school drill, my impression is that they come 
for the most part later in life, after the children have 
left school, and because of constitutions weakened dur- 
ing the school years, instead of strengthened, as they 
should be. The causes of this serious evil lie partly in 
matters which can be, and should be, corrected in the 
schools, but fully as much, if not more, in conditions 
for which the home and the parents are responsible. 

The definite defects or evils in our school system 
seem to me chiefly due to, first, over-pressure beyond 
the age or strength of the pupil ; secondly, to bad air ; 
and thirdly, to lack of physical exercise. In the first 
place, as to the age and hours of study of the pupils. 
There should be none admitted under the age of five. 
Of course, that is not a prevalent fault in Boston, as 
there are only half a hundred so young, out of a total of 
62,000 of all ages, in that city. There are seven or 
eight thousand, a varying number, under the age of 
seven. For these children five hours' school work a day, 
even with the two hours' interval for dinner, seems to 
me altogether too mych. From the age of seven to 
thirteen, I think that there should be no study outside 
of school, except possibly a review of some of the day's 
work for the children from ten to thirteen years old ; 
and, after that age, not more, as a rule, than an hour of 
home study until the end of the high school or Latin 



178 DISOEDERS OF THE NERVOUS SYSTEM. 

school course. Naturally, some j^ouths caunot do so 
much as that; a certain number can do more with 
safety. I am aware that many of the teachers, perhaps 
most of them, or nearly all of them, endeavor to correct 
the tendency of conscientious pupils to study too much 
at home ; but that does not entirely meet the difficulty, 
which can only be done by placing definite limits of age 
and hours of study for the various classes. In the 
primary schools, and in the lower three classes of the 
grammar schools, where there is supposed to be no home 
study, and the teaching is so largely independent of 
books, naturally only a limitation of school hours is 
needed according to age, provided the present rule not 
to study at home is obeyed. Of course, if children be- 
gin full study in the schools at an age so early as to do 
harm from over-pressure, the evil not only lasts through 
the whole school life, but it is cumulative, and is sure to 
more or less affect them as long as they live. 

Competitive examinations for prizes or rank, the 
privilege of skipping classes by rapid promotion, and 
the rehearsals for annual festivals, have seemed to me 
in some cases to have done harm. Perhaps it will be 
possible to so regulate them as to retain the incentive 
for good work and not put too heavy a strain on chil- 
dren of sensitive and active minds. Single promotions 
are dangerous enough, and, I think, should be allowed 
only with the exercise of greatei; care than is common 
now. But what have I to express for double and triple 
promotions, for allowing an ambitious girl to skip at 
one leap two, even three, classes ? Nothing but unquali- 
fied disapproval. 

The fact is too often overlooked that intellectual 



DISORDERS OF THE NEItVOUS SYSTEM. 179 

brightness in children may be only a symptom of ill- 
ness. At all events, excitable, prococious children are 
not infrequently stimulated to overwork, when their 
proper place is in the doctor's hands. 

Next to beginning school work at too early an age, 
by far the greatest direct evil, or sin of commission, in 
our schools, is bad air, especially where the school-rooms 
are over-crowded, as many of the primary schools are. 
Its influence in spreading infectious diseases is not to 
be overlooked, but it is ten times more injurious to the 
nervous system, from undermining the constitution by 
a slow poison. It causes headache, weariness, impaired 
appetite, enfeebled digestion, fretfulness, irritability, 
with a whole train of evils, for which over-pressure in 
study is falsely accused. At the same time that this 
evil is remedied, means should be taken to avoid the 
inequality of temperature, especially in the larger school 
buildings, which is, for the most part, a matter of coal 
and care. In the summer time, it seems to me that the 
schools should always be dismissed when the tempera- 
ture exceeds 82° Fahr. I know that pure air in large, 
crowded buildings is costly, and I suppose that proper 
ventilation in our schools would involve an additional 
amiual expense of, perhaps, ten or twenty thousand dol- 
lars ; but the outlay would be more than repaid, and for 
the present condition there is not a shadow of excuse. 

Among the home influences acting unfavorably, 
absence of sunlight in narrow streets, impure air, and 
insufficient diet are in some cases, and to a certain 
extent, unavoidable. An unwise diet, or injudiciously 
selected, is more common, even among those who can 
afford for their children an abundantly nutritious fare. 



180 DISORDERS OF THE NERVOUS SYSTEM. 



I 



A great part of the harm from bad ventilation is loss of 
appetite, for which the child craves stimulants, and the 
parent yields to the v^^ish for tea and coffee, which only 
enormously aggravate the evil. I rarely see at the 
hospital a child from the public schools whose health 
has not been injured by these stimulants, and then 
comes again the complaint of over-pressure. Cigarettes 
are a source of harm chiefly in the private schools, but 
sometimes in the public schools also. 

In the high schools, the pupils are at an age when 
abundant and nutritious food is needed at intervals of 
not more than four or five hours. How often do we 
hear carelessness or inattention in this respect excused 
by the parent or teacher, on the ground that the child 
is not working, only going to school, and so not in need 
of a full diet ; whereas the fact is just the opposite, that 
brain-work is the most exhausting kind of work, to 
meet the demands of which the brain should be thor- 
oughly well nourished by abundant, nutritious food. 
The long sessions and the great distance of the schools 
from the homes prevent sufficient. nourishment for many 
of the nearly two thousand pupils in the high and Latin 
schools, and again there arises impaired health for which 
over-pressure is the assigned cause. 

Toward the latter part of the grammar school life, 
and during the high and Latin school period, the tired 
backs and heads needing fresh air and exercise get still 
more tired from sitting at the piano ; outside duties and 
pleasures are allowed to overweary, more especially the 
girls, or to break in upon the hours of sleep, and this 
oftener does harm in my opinion than over-study ; at 
least, social cares, and dissipations, and accomplish- 



DISORDERS OF THE NERVOUS SYSTEM. 181 

ments, cannot be safely combined with full school duty 
to any great extent; one or the other must be curtailed. 
The strain comes, too, at a time of active physiological 
development, when especial care should be taken that 
there should be abundant rest and sleep, with plenty of 
nutritious food and healthy out-door life. I have seen 
enough to convince me that want of proper care at this 
time does much harm, particularly in girls, that never 
can be fully remedied in later life; and yet the too 
ready resort to the bed or the lounge for slight ailments 
in girls and women seems to me to be creating invalidism, 
the blame of which is often laid to over-pressure or to 
inherent weakness of the female sex. The boys play 
and romp and have their military drill, but the girls 
have not the opportunity for that vigorous physical 
exercise which they need fully as much as the boys. 
Being more sensitive and emotional by nature, we delib- 
erately bring them up so as to exaggerate these quali- 
ties and make them less strong and less self-dependent 
in later life. By the last record there were six thou- 
sand two hundred and twelve girls thirteen years old 
and over in our Boston public schools. Most of them 
who are in good health are better for continuous work; 
many who are subject to occasional disturbances would 
do best to disregard them to a certain extent, but a 
large number cannot do so with safety. One high 
school teacher in the western part of Massachusetts 
states that the girls in his school are excused from work 
simply at their request, and that, speaking from general 
impressions, he should say that they are absent from 
school one-tenth of the time. I doubt whether accu- 
rately kept statistics would fully bear out his statement 



182 DISORDERS OF THE NERVOUS SYSTEM. 

as to the amount of absence from school of the girls. 
If the fact is as reported, I am confident that harm is 
done as well as good, but that more care is needed in 
this respect than is common, I am quite sure. 

If there is any defect or imperfection in the eyes, or 
ears, or lungs, or heart, or anywhere, as is not unfre- 
quently the case, there is almost always a sensitiveness 
of the nervous organization, and a diminished capacity 
for work which renders especial care quite important. 
With an imperfect eye, the brain works harder to secure 
perfect vision. It is just the same with any other 
imperfect organ in performing its proper function, and 
hence undue weariness. These anatomical or physiologi- 
cal defects are so common, particularly in the eye, and 
they so often lie at the bottom of impaired health and 
nervous disorders, that it would be well for all parents 
to know whether their children are free from them, cer- 
tainly before they are put to the strain of the higher 
courses of study, involving prolonged and concentrated 
mental effort, and preferably before the grammar school 
age. 

The two diseases of the nervous system most com- 
monly attributed to the schools are chorea or Saint 
Vitus's dance and epilepsy. I have never yet, however, 
seen one case of either disease, the causes of which did 
not seem to me to lie more probably in accidents or 
injuries to the brain, or, at least partly, in circumstances 
and conditions outside of the schools. I do not mean to 
say, however, that there are not schools which may be 
blamed even to this extent. It would not surprise me, 
if, on a careful search, several such were found. 

When our first secretary of the State Board of Edu- 



DISORDERS OF THE NERVOUS SYSTEM. 183 

cation made such vast improvements in our public 
schools, he got manj^ of his best ideas from Germany ; 
and if we should go to Germany now, we should find 
that the Germans are just as far ahead of us at the 
present time as they were then, and in this respect 
chiefly, that, in their best schools, a system begun and 
most thoroughly carried out in Frankfort and Berlin, 
all the pupils are trained just as regularly and just as 
carefully in gymnastics, in physical exercise, both girls 
and boys, as in arithmetic and geography. This is a 
thousand times better than all the rest cures, and mind 
cures, and everything of the sort. 

There is one immense influence of our public schools 
which I have been surprised to find quite generally 
ignored, namely, its great power in training the mind 
and developing character. It teaches self-respect and 
self-control, and furnishes internal resources for the 
struggles of after life, which seem to me one of the 
chief safeguards of society. Hard work is needed by 
nearly all of us. There are few persons who are not com- 
pelled, at some time in their life, to learn the necessity 
of not only doing disagreeable things, but of doing 
them easily, and home discipline is apt to be too de- 
fective in these points. If it were not for the public 
school training, thousands of children would grow up 
like weeds or Topsies, their fathers and mothers being 
too busy inculcating the filial duties to remember the 
obligations of parents to their children. 

There is, without doubt, overstudy at home in some 
cases, and harmful overstudy, and there can be no 
system devised which will make it impossible. The 
amount of study which may be given to the lessons in 



184 DISOEDERS OF THE NERVOUS SYSTEM. 

any but the lower grades in the schools is practically 
without limit, if the student aims for perfect marks or 
is interested to go to the bottom of the subject, and then 
he simply exhausts himself. If this is done, it is not 
necessarily the fault of the schools, but oftener of the 
individual for persisiting in overwork, or of the parent 
for encouraging or allowing it. All that the teacher 
can do, given a not excessive course of study, is to 
advise and warn, which certainly is freely done in some, 
at least, of the Boston schools. 

With regard to the diseases and disorders of the ner- 
vous system in adults, attributable to the schools, I 
have seen enough to convince me that many constitu- 
tions are impaired in the schools, and chiefly from 
causes which I have already pointed out. I think, how- 
ever, that at least three-fourths of the causes of 
nervous exhaustion and nervous disorders generally lie 
outside of the schools, in natural physical disabilities, 
in unwise methods of living, especially in breathing too 
little fresh air, in neglect of physical exercise, in not 
heeding early symptoms of disease, too often in the 
resort to the habitual use of stimulants and narcotics, 
including the excessive use of tea, coffee and tobacco, 
those curses of nervous people. The functional diseases 
and disorders which make life wretched, without kill- 
ing, are at least four times as common among women 
as among men, and the, to me, foolish conclusion is 
drawn from that fact that women are unfit for hard 
work, and responsible duties, and severe mental train- 
ing. On the contrary, they are driven by their few 
resources to those branches of industry involving the 
most worry, the worst air, the least pay, and the great- 



DISORDERS OF THE NERVOUS SYSTEM. 185 

est anxiety, and tliey are denied the opportunity of 
that vigorous physical exercise and sound mental 
discipline without which men know perfectly well that 
they would be neuralgic, dyspeptic and suffering from 
all that is implied in the expressive word "nerves." 
Phj^sical defects and imperfections are more trying to 
women than to men, and more is demanded of them in 
the way of maintaining a respectable appearance and 
living. What they need most is more, rather than less 
training ; perhaps in some respects better training of the 
kind such as the public schools give, more colleges for 
women, more physical exercise, more knowledge how to 
take care of themselves, more opportunities in every 
direction. If women had all these, we should soon 
hear and see much less of the so-called nervous prostra- 
tion and of the evil effects of over-pressure. Wear 
and tear in their work is greater than in men's work, 
and they need that higher education which is fast 
teaching the few to whom it is accessible how to live 
and keep their health. The colleges for women already 
established, as I read tlie evidence, have shown con- 
clusively that the firmer mental balance which women 
get thereby is already telling in improved physical 
health. We do not see the graduates of them working 
all day, studying in the horse cars, snatching out a book 
between the acts at the theatre, and reading until mid- 
night, kept up by tea, in order to converse intelligently 
about the last novel. In face of the many obstacles 
against which women in general have to contend, they 
must work harder, with greater worry and with more 
disappointments than men. There are more conditions 
necessary to avoid failures in women. Of course they 
break down earlier and oftener than men. 



186 DISOEDEES OF THE NERVOUS SYSTEM. 

The physician sees constantly most lamentable break- 
downs in young men and in young women who are 
struggling, against great difficulties, for an education 
— probably more, in proportion to the whole number, 
among young women than among young men, because 
the young women are in a field of effort which has not 
3'^et entirely passed the experimental stage, and they are 
still learning how much they can do and in what way 
they can best do it. In denying themselves sufficient 
recreation, fresh air, physical exercise, rest, sleep, food, 
in working late at night for the money to pay a debt, buy 
a coveted book, or provide the daily dinner, in failure 
to recognize physical limitations of health and strength, 
in the hurry to do five years' work in four or three 
years, in the wear and worry of outside anxieties, they 
often deliberately, often ignorantly, run great risks, as 
a result of which there must be a certain proportion of 
ruined health. Of a hundred brains strained to the 
average limit of tension many must break, but the 
fault, or the mistake, is, for the most part, with the 
individual. 

In the present stage of the question of the higher 
education of women, while originality of thought, inde- 
pendence of social prejudices, activity and receptivity of 
mind, rather than soundness and stability of constitu- 
tion, must characterize the young people who take it 
up, it is quite natural that the nervous or neuropathic 
temperament should predominate among them ; that 
there should be many of unstable equilibrium, of sen- 
sitive physical organization, who break down easily 
whether they study or not. My own opinion is that 
even for these — I would rather say especially for these 



DISORDERS OF THE NERVOUS SYSTEM. 187 

— the higher education is a conservative, rather than a 
destructive, force. But they must learn that they need, 
in their management of themselves, more care and more 
self-control than others. 

By the last census there were, within the ages of 
active work, from sixteen to fifty inclusive, in the state 
of Massachusetts, 52,483 more women than men. 6,413 
of them taught school, as compared with 923 men, so 
that the question has already become a practical one. 
After the great Boston fire, fifteen years ago, it was 
perfectly pitiful to see how few useful and remunerative 
things the young women thrown out of employment 
could do. 

I shall naturally be asked what can be done so far as 
our public schools are concerned? I am not one of 
those optimists who think that a legislative enactment 
or a commission or a board with a chairman and a 
secretary can relieve all the difficulties of the world. I 
am quite sure that skilled and experienced medical 
opinion ought to be more brought to bear upon these 
questions than it now is ; but that would involve a 
great deal of time and much discussion. 

What is there which can be done at once? In the 
first place, as I have already intimated, vastly greater 
injury is done to the nervous organizations of children 
at home than in the schools, and the greatest part of 
this comes from ignorance. The readiness of mothers 
to carry out sensible advice regarding their children's 
health convinces me that much can be done by system- 
atic attempts to instruct them. 

In the second place, the air of the schools should be 
made better at whatever cost. 



188 DISORDERS OF THE NERVOUS SYSTEM. 

Thirdly, means of physical exercise should be pro- 
vided for all weathers, especially for the girls, who have 
not now even the defective advantages possessed by the 
boys in that respect, and as regular hours should be 
devoted to gymnastics as to mental training. 

Fourthly, regarding the teachers. Under the im- 
proved methods of instruction, with fewer text-books 
for their pupils to memorize, the work is much harder 
for them than before. The slow poison which the 
children breathe in for a few years from the badly ven- 
tilated class-rooms, at a time of life when there is 
naturally a superabundance of the tendency to healthy 
processes, and a great power of throwing off all sorts 
of injurious influences, the teachers must breathe, year 
in and year out, at a time of life when they have little 
superfluous strengtli, and, if anything, are almost daily 
overtaxing what they have. The tenure of their posi- 
tions should be as free from worry as is compatible with 
good service, and they should, like the professors at 
Cambridge, have a year's furlough at stated intervals, 
without losing their places. 

On these four points, I think that there can be no 
real difference of opinion among competent and thought- 
ful persons who have given the subject suflicient atten- 
tion. 

With regard to the hours of study for children of dif- 
ferent ages, I am aware that there will be a wide diverg- 
ence of views among those who have carefully considered 
the matter. I can only repeat my own conviction that 
full school hours are begun at too early an age in the 
Boston public schools, and that only evil can come of it. 
I believe, too, just as strongly, that the fact has been 



DISORDERS OF THE NERVOUS SYSTEM. 189 

diemonstrated that children under fourteen years of age 
cannot bear much, if any, more than an hour's continu- 
ous study profitably, perhaps not without harm, and 
that for them each hour's brain-work should be followed 
by ten or fifteen minutes in the open air in fair weather, 
and exercise or recreation in all weathers. This is 
accomplished to a certain extent and for pleasant days 
by our recesses, but I am informed that a suggestion is 
made, which I earnestly hope is not the case, to abolish 
those very useful breathing spaces. 

For children of fair strength and average ability, liv- 
ing under reasonable conditions of health, in the school 
and out of the school, is the present course of study in 
our public schools in Boston one to cause over-pressure 
and disorders of the nervous system, provided the 
pupils begin at the age of seven, or do half-time study 
from six up to that age, with few hours and little but 
object lessons from five to six ? 

My very decided opinion is that there is harmful 
over-pressure, and that there is room for further improve- 
ments in the direction in which I have intimated that 
so much has already been admirably done of late years. 
I am quite sure that bright children are promoted too 
rapidly, and that the number of studies can profitably 
be diminished for nearly each day's calendar, in the 
upper classes of the grammar schools and in the high 
and Latin schools. 

I will repeat my opinion already stated, that the 
greater part of the ill-health commonly attributed to the 
schools arises in conditions for which the responsibility 
belongs to the home and to the parents, perhaps in a 
certain degree to social customs and to society at large. 



190 DISORDERS OF THE NERVOUS SYSTEM. 



The correction of this difficulty is no easy matter. I: 
some cases it is beyond the parents' power to do other^ 
wise than they are doing ; foolish subserviency to what 
they consider fashion controls many more, and the work 
of educating others up to a full sense of their obliga- 
tions to their children, and to a knowledge how to do 
what is best for them, is one requiring time and patience. 

The greatest difiiculty will be found in attempts to 
adjust the school work to different degrees of health and 
strength, especially to the different manifestations of 
the nervous constitution. How far this should be done 
by the parents, how far by the school authorities, at what 
age different children should be allowed to go to school, 
how far the school course should be modified to suit 
their capacity, who shall decide what studies shall be 
dropped, and when certain pupils shall leave school for 
a while, — in a word, to what extent the training of fifty 
thousand children shall be individualized, — these are 
all most important and interesting questions which 
must be met in a variety of ways. 

Whether or not the schools are adding to the total 
amount of nervous instability, and disease or disorder of 
the nervous system in the community ; whether or not 
the confessed injury done by the schools is counter- 
balanced, or more than counterbalanced by the enor- 
mous good which they do, one fact is beyond question, 
namely, that the schools do not do all they can, and 
ought, to counteract the tendency of the age to all sorts 
of physical ills arising from the high-pressure rate of 
living, the high social tension which we see everywhere. 
Can we afford, simply as a matter of social and political 
economy, to allow them to do any less than their 



I 



DISORDEKS OF THE NERVOUS SYSTEM. 191 

utmost in this respect, when we consider that at any 
given time one-eighth of the population of the city is in 
the public schools, and that there are comparatively 
few others who at some time have not been, or will not 
be, under their care? 

In the city of Brussels each school is visited weekly 
by a trained medical inspector, who examines the school- 
rooms for suggestions regarding improvement in con- 
struction, ventilation, heating, etc. He looks after the 
condition of the air, drains, and all matters affecting 
the health of the pupils. He sees that the temperature 
of the rooms has been recorded four times a day, and 
he compares for himself the temperature at different 
places, — near the floor, on a level with the pupils' 
heads, and toward the ceiling. He prescribes the 
various means and methods of exercise, including the 
out-door gymnastics ; directs the walks, excursions, and 
instruction in swimming, carefully looking over each 
child to see whether he or she is strong enough for the 
full school routine in these respects as well as in the 
matter of studies. If, in summer, the temperature ex- 
ceeds 28° C. or 82.4° Fahr., he dismisses the school, and 
may order pleasant walks in place of the regular school 
duties. He is to superintend the physical development 
of the pupils, and to advise against too fatiguing 
methods or courses of study. He keeps records, taken 
at regular intervals, of the height, weight, general con- 
dition, etc. of each pupil, which constitute a sort of 
life history, to be carried home and kept by each one 
upon leaving school. He instructs the teacher how to 
recognize infection-diseases in their early stages, and 
sees that the regulations regarding them are enforced. 



192 DISORDEES OF THE NERVOUS SYSTEM. 

He devotes especial care to the weak and sickly chil- 
dren, to see that they get the best possible result from 
the school training, supplying to them medicines, cliiefly 
tonics, free of cost. Children under fourteen years of 
age, after each three-quarters of an hour's study, have 
fifteen minutes for recreation, which must be in the 
open air, when the weather allows it, and this the 
medical inspector regulates. The physical examina- 
tions of the pupils include particularly the eyes, any 
defects in which are corrected, so far as is possible ; and 
the dentist for the schools treats, on an average, about 
ten pupils each school day. 

In Frankfort-on-the-Main there have been buildings 
for gymnastic exercises connected with the public 
schools, but entirely separate from them, and supported 
by the public, for more than thirty years. There are 
eighteen" such in the city, beside a number of large 
halls for gymnastics in school-buildings and out-of-door 
grounds, arranged with the usual appliances of a gym- 
nasium. There are more than a hundred teachers of 
physical exercises. The children are also taught swim- 
ming, and take numerous walks and excursions, under 
the guidance of teachers, for pleasure and instruction. 
There is not the same systematic medical inspection as 
in Brussels, but the pupils are examined by physicians, 
as required, to guard against infection-diseases, and to 
provide lowered standards of work, in studies and in 
physical exercises, for those who are not sound in mind 
or in body, as the case may be. Each hour's study is 
followed by several minute's recreation, out of doors if 
the weather permits. Once a year the pupils of the 
public schools have a day's excursion into the country, 



DISORDERS OP THE NERVOUS SYSTEM. 193 

and shorter pleasure trips are also made, from time to 
time, usually Saturdays. 

In the long summer vacation, nearly two hundred 
feeble pupils are selected for a month's visit among the 
hills and fields — this, however, is at private cost, by 
subscription, and is under the direction of persons com- 
petent to look after the boys and girls, and to instruct 
them in general deportment, diet, and the laws of 
health. 

The Germans and the Belgians tell us not only that 
they are satisfied with the results, but that they are 
demanding from the authorities further advances in the 
same direction; that they spend more money on their 
schools, but believe that they shall thereby lessen the 
expenditure for prisons and poorhouses and hospitals 
and jails. 



II^DEX. 



Il^DEX. 



[The numbers refer to pages.] 



DRAINAGE. 



Air, pollution of, 127. 

Air-iulets, 140. 

Air-vents, 150. 

Assumption of cleanliness, 155. 

Bell-traps, 149. 

Catch-basins, 130. 

Cellars, 140. 

Cesspools, 136. 

Drainage ; importance of the sub- 
ject, 154. 

Drains, definition of, 115. 

Filth diseases, 120. 

Filth, how introduced into the sys- 
tem, 113. 

Germs of disease, IIH. 

Germ-theory of disease, 117. 

Grease-traps, 135. 

House-drains, 134. 

House-drains, best materials for, 134. 

Ice-box, 142. 

Joints of pipes, 144. 

Peppermint test, 144. 

Sanitary reforms ; their effect on 
health, 119. 



Sewage, definition of, 115. 

Sewerage, definition of, 115. 

Sewers, 129. 

Sewers, definition of, 115. 

Sewers, veutilation of, 130. 

Sewer gas, 115. 

Soil-pipes, 143. 

Soil-pipes, ventilation of, 144. 

Soil-pipes, necessity for ventilation 
of, 145. 

Traps, 137. 

Traps, unreliable under certain condi- 
tions, 149. 

Trapping of fixtures, 147. 

Trapping of fixtures, best method 
of, 147. 

Trapping of house-drains, 137. 

Wash-bowls and bath-tubs, 153. 

Water-closets, 151. 

Water-closets, varieties of, 152. 

Water, Heisch's test for, 127. 

Water, pollution of, 123. 

Water supply for fixtures, 147. 



EPIDEMICS AND DISINFECTION. 



Boston Board of Health, 98-103, 108. 
Boston City Hospital, 101, 102, 107. 
Chicken-pox, 98. 
Cholera, 95-97. 
Contagious diseases, 93. 



Diphtheria, 96, 98, 102. 
Disinfection, 99, 109. 
Endemic diseases, 92. 
Epidemic diseases, 92, 94. 
Infectious diseases, 93, 99, 102, 105. 



198 



INDEX. 



Isolation, 97, 107. 

Itch, 93. 

Koch, 100. 

Laws, regulating attendance at 
school, 101, 103-105. 

Leprosy, 93. 

Mass. Registration Reports, 105, 106. 

Measles, 98, 103. 

Medical Officers of Schools' Associa- 
tion, England, 108. 

Memphis, 95. 

Pasteur, 100. 

Plague, 94. 

Scarlet fever, 96, 98, 100-102. 



School committee, 108. 
Small-pox, 95, 96, 99, 100, 
Supervision, Medical, of Schools, 108 
Supervision, Medical, of Schools in 

Brussels, 108. 
Supervision, Medical, of Schools in 

Cleveland, 108. 
Truant officers, 108. 
Typhoid fever, 93, 96, 97, 103. 
Vaccination, 95, 99. 
M'^hooping cough, 98. 
Yellow fever, 95. 
Zymotic diseases, 93. 



1 



EYES OF SCHOOL CHILDKE:N". 



Asthenopia, 86. 

Desk, height, and inclination of, 74. 

Dress, avoid tight fit about neck, 80. 

Electric light, arrangement of, in 
Liittich, 74. 

Exercise, comparative hours for, 
among German, French, and Eng- 
lish boys, 79. 

Eyeball, normal shape of, 66 ; shape 
in hypermetropia, 82 ; shape in 
myopia, 66. 

Eyes, need of care in use of, 87. 

Far-sightedness, see Hypermetropia. 

Germans, percentage of myopia 
among, 65, 68, 69, 71, 73. 

Glasses, use of, concave for myopia, 
66, 82 ; use of, for reading, 84 ; use 
of, in beginning strabismus, 85 ; use 
of convex, for hypermetropia, 86. 

Grammar schools, study hours in, 79. 

Home lessons, number of hours for, 79. 

Hyi^ermetropia, accommodative effort 
of eyes in, 84 ; more noticeable after 
general illness, 85 ; relation to stra- 
bismus, 85 ; eye more liable to 
fatigue, 84. 



Legibility of letters or words, 76. 

Letters, size of, 77. 

Light, amount of, in school-rooms, 73 ; 
arrangement of, in school-rooms, 72. 

Myopia, affected by lighting of school- 
rooms, 73 ; causes of, 66-68, 71, 
75-80, 82 ; changes in deeper parts 
of eye in, 67 ; dangerous to the 
eyes, 65, 68 ; exercise as a preven- 
tive of, 80 ; hereditary tendency of, 
66, 71, 72 ; increase of, during school 
life, 65, 69, 71, 72 ; increase of length 
of eye in, 66 ; often accompanied 
by disease of the eye, 65, 67, 68 ; 
parallel rays of light focussed in 
front of retina, 66 ; percentage of, 
in children of different nationali- 
ties, 68, 71 ; period of greatest 
development, 67, 87 ; prevention 
of, 72-80, 88 ; progressive tendency 
of, 67-69 ; tests for, 81. 

Myopic eyes not stronger than 
others, 70. 

Near-sightedness, see Myopia. 

Primary schools, study hours in, 79. 

Print, minimum size of, 77. 



INDEX. 



199 



Reading, accommodation of eye for, 
83 ; interrupted use of eyes in, 75 ; 
muscular action in, 70 ; proper 
position for, 74, 75. 

Seating of scholars, 74. 

Seats, size and height of, 74, 75. 

Slate, use of, in German schools, 77. 

Squint, see Strabismus. 

Strabismus, in fixed cases early oper- 
ation needed, 85 ; often relieved by 



proper glasses, 85 ; relation to the 

accommodation of the eye, S5 ; 

tends to diminish visual power, 85. 
Tests for myopia, 81 ; for visual 

power, 81. 
Visibility of letters or words, 76, 77. 
Weak eyes, see Asthenopia. 
"Windows of school-room, height of, 

73 ; area of, 73. 
Writing, proper position for, 74. 



THE RELATION OF OUR PUBLIC SCHOOLS TO THE 
DISORDERS OF THE NERVOUS SYSTEM. 



Adjustment of school work to indi- 
vidual constitutions, liK). 

Certain diseases ; their causes erro- 
neously attributed to the schools, 
182. 

Charity preserves infant life, 165. 

Defects in the school system, 177. 

Degeneracy of the human race in 
cities, 167. 

Delicate children, treatment of, 174. 

Diseases of the nervous system ; their 
causes ditiicult to explain, 168. 

Enfeebled constitutions in the young ; 
how produced, 186. 

Examinations, 178. 

Eyes, defects in, related to sensitive- 
ness of the nervous organization, 
182. 

Functional disorders more common in 
women, 184. 

Generalizing from a single case of 
disease, fallacy of, 169. 

Germany compared with America, 
183. 

Girls, effects of overpressure on, 181. 

Higher education for women ; its 
physical advantages, 185. 



Hours of study, 177. 

Huxley's doctrine, 176. 

Improved sanitation, effects on health 
of, 163. 

Impure air in school-rooms, 179. 

Increase of diseases of the brain and 
nervous system, causes of, 164. 

Insufficient food, the cause of ill 
health, 180. 

Intermission from study, 189. 

Medical inspection of schools in Brus- 
sels, 174, 191. 

Medical inspection of schools in 
Frank fort-on-the-Main, 192. 

Mental and physical types, changes 
in, 162. 

Methodsof education, old and new, 161. 

Mill's doctrine, 176. 

Modern life ; its tendency to physical 
strain, 166. 

Nervous exhaustion, cause of, 184. 

Nervous temperament, a benefit to 
society, 173. 

Nervous type of character, develop- 
ment of, 163. 

Neuropathic constitution, symptoms 
of, 172. 



200 



INDEX. 



Outside duties increase mental strain, 
180. 

Overpressure in the Boston scliools, 
189. 

Overpressure, tendency to, not coun- 
teracted by the schools, 190. 

Oversight of teachers beneficial, 175. 

Prevention of nervous disorders in 
children, 187. 

Prevention of nervous disorders in 
teachers, 188. 



i 



Proportion of women to men in 

Massachusetts, 187. 
Public schools, influence of.indevelop- 

ing character, 183. 
Sanitation ; its effect on nervous 

disorders, 166. 
Standard of health of public school 

children, 176. 
St. Vitus' dance, 174. 
Training of the young, a prevention 

of nervous diseases, 168. 
Unfavorable home influences, 179. 



SCHOOL HYGIENE. 



Drainage, 15. 

Eyes of school children, 18. 

Exercise, 28. 

Fresh air, best methods for introduc- 
tion of, 12. 

Fresh air, definition of, 8 ; quantity 
of, required, 10. 

Furnaces, 13. 

Half-time system in education, 24. 

High temperature, cause for one ses- 
sion, 25. 

Hours for study, proper number of, 22. 

Hygienic errors, when most dan- 
gerous, 23. 

Impure air, best methods for removal 
of, 11. 

Mass. Emergency and Hygiene Asso- 
ciation ; its origin, 2. 

Mass. Emergency and Hygiene Asso- 
ciation ; its work, 3. 

Medical Inspector of schools, 30. 

Near-sightedness in school children, 
causes of, 18. 

Nervous systems of school chil- 
dren, 20. 



Overcrowding, 10. 

Overheating, 8. 

Overwork, 22. 

Overwork, its effects on girls, 26. 

Overpressure in English schools, 21. 

Privies of school-houses, 17. 

Recitation rooms, 15. 

School exhibitions, 26. 

School hygiene, necessity for instruc- 
tion in, 4. 

School lunches, 25. 

School sessions, 24. 

Situation of school-houses, 5. 

Statistics of mortality from nervous 
disorders, 21. 

Stoves, 13. 

Teachers, duties of, 30. 

Teachers, effects of overwork on, 27. 

Temperature of school-rooms, 9. 

Ventilation and heating, 6. 

Ventilation by open windows, 14. 

Ventilation, defective, in school- 
rooms, 8. 

Wells of school-houses, 17. 



INDEX. 



201 



VENTILATION AND WARMING. 



Air, composition of, 37. 

Air-space required in school-rooms, 49. 

Air-supply, how warmed properly, 57. 

Arsenical dust in the air, 47. 

Artificial ventilation, its princi- 
ples, 54 ; its requisites, 56. 

Carbonic acid in the air, 38, 42. 

Diffusion as a force in natural ventila- 
tion, 50. 

Dust in the air, 46. 

Effects of breathing unrenewed air, 47. 

Exhaust-system of ventilation, 60. 

Fireplaces commended, 61. 

Foul air, how extracted, 60. 

Foul air, outlets for, 59. 

Furnace-heating, 57. 

Heat, a motive force to dispose of 
used air, 61. 

Heating appliances, 57. 

Humidity of the air, 40. 

Inlet for fresh air, 56, 58. 

Life saved by ventilation, 48. 



Maxims for school ventilation, 63. 

Natural ventilation not reliable, 53. 

Organic matter in the atmosphere, 46. 

Outlets for foul air, 59. 

Oxygen as a component of air, 37, 39. 

Purification of the air by natural 
forces, 45. 

School-room air, 47. 

Shafts for foul air, how managed, 60. 

Sources of fresh air in artificial 
ventilation, 55. 

Steam-heating, 57. 

Temperature of rooms, 57, 58. 

Thermometers, how used, 58. 

Ventilation defined, 35. 

Ventilation and warming closely 
related, 36. 

Windows to be opened in school 
intermissions, 52. 

Winds, and their effect on ventila- 
tion, 51. 



^K8S of 

Boston. 



GINN, HE A TH, &> CO:S PUBLIC A TTGNS. 

The Foundation of Death. 

A Study of the Drink Question. By Axel Gustafson. American 
Copyright Edition. 629 pp. i2mo. Cloth. Mailing price, ^2.00; 
Introduction price, §1.60. 

As may be learned from the subjoined notices, this book has 
already been accepted in England as the most complete work on 
the subject ever published, and one that will be " the Bible of tem- 
perance reformers for years to come." It is pronounced the fairest, 
most exhaustive, freshest, and most original of all the literature on 
the subject that has yet appeared. It is impartial and careful in its 
evidence, fair and fearless in its conclusions, and its accuracy is 
vouched for by the best physiologists and physicians. 

The book was not made to prove a theory, but was the out- 
growth of a pure and unprejudiced seeking after the truth. The 
drinking habits of the English people, as they were illustrated in 
the streets and homes of London, first led the author to examine 
the drink question, and " The Foundation of Death" is the outcome 
of his researches. 

In preparation for this work, the author has made exhaustive and 
impartial researches in the alcohol literature of nearly all countries, 
having examined, in the various languages, some three thousand- 
works on alcohol and cognate subjects, from a large proportion of 
which carefully selected quotations are made. 

It contains a bibliography of over 2000 works, arranged chrono- 
logically, and the works of each country separately. As far as has 
been possible, all departments of this study have been brought up 
to date. 

The scope of the work, as to the variety of standpoints from 
which it is treated, is indicated in the following list of chapters. 

I. Drinking Among the Ancients. 
II. The History of the Discovery of Distillation. 

III. Preliminaries to the Study of Modern Drinking. 

IV. Adulteration. 

V. Physiological Results ; or, the Effects of Alcohol on the Phy- 
sical Organs and Functions. 
VI. Pathological Results ; or, Diseases caused by Alcohol. 
VII. Moral Results. 



MTSCELLANE O US. 



VIII. Heredity ; or, the Curse entailed on Descendants by Alcohol. 
IX. Therapeutics; or, Alcohol as a Medicine. 

X. Social Results. 
XL The Origin and Causes of Alcoholism. 
XII. Specious Reasonings concerning the Use of Alcohol. 
XIII. What can be done. 



Cardinal Manning' : I have seen 
enough of it to say that I know of no 
other work so elaborate or so complete. 
The immense mass of miscellaneous 
knowledge contained in it can, so far 
as I know, be found nowhere else ; and 
the arguments by which you prove the 
perilous and pernicious effects of intox- 
icating drink, in all its forms, are, in 
my judgment, irresistible. 
{^Aug. 13, 1884.) 

W. S. Caine, M.P.: It is not possible 
to speak too strongly of its great value to 
the temperance movement. It should 
be in the library of every politician and 
social reformer. {Aug. 12, 1884.) 

Canon Ellison, Chairman of the 
C. E. T. S. : I can conceive nothing 
better calculated to awaken enthusiasm 
in temperance reform where it does 
not yet exist, or to sustain it where it 
does. {Aug. 5, 1884.) 

Rev. Newman Hall : The book 
bids fair to be for many years to come 
the text-book of temperance reformers. 
{Aug. 5, 1884.) 

Samuel Morley, M. P. : The 
more I have thought on the subject, the 
more convinced I am that the book 
will supply a want much felt. 

Stopford A. Brooke : It has been 
done with sincere fidelity to the subject. 
In fact, it is just what is wanted, — a 
book eminently usable, which will sup- 
ply in portable and admirable form the 
ground-work of lectures, addresses, etc. 



Dr. B. W. Richardson, in the 

Asclepaid : For a long time it will be 
a text-book among temperance re- 
formers. 

Dr. Janaes Edmunds, Senior 
Physician, London Temperance Hos- 
pital : The scientific and physiological 
data are very exact and well digested, 
and I think it will prove the best vol- 
ume now before the public. 

Dr. Norman Kerr: This great 
work will, I feel convinced, have a pro- 
found and permanent influence on the 
educated mind, and on the public 
opinion of America, Britain, and the 
continent of Europe. 

Dr. Robert Laird Collier: It is 
an original and thorough treatment of 
the subject, and must become a perma- 
nent text-book in the literature of tem- 
perance. The book is as interesting 
as a novel, and as instructive as a treat- 
ise on science. 

Hon. Neil Dow, Portland Me. : 
I have examined it with great satisfac- 
tion. It is an admirable work, and 
ought to be in the hands of everybody 
who takes an interest in the solution of 
the great problem. It is a resume of 
all that concerns the relation of alco- 
holism to the individual and to society. 
{Sept. 3, 1884.) 

Dr. Daniel Dorchester, Natick, 
Mass. : I regard it as a volume of un- 
usual value, and very timely. It will 
command close study and be of great 



220 



GINN, HE A TH, &^ CO:S PUBLIC A TIONS. 



service to clergymen and other temper- 
ance workers, teachers of hygiene and 
temperance, and all who desire to un- 
derstand the alcohol question. It 
comprises the latest scientific data 
bearing on the subject of alcohol. 
i^Sept. 5, 1884.) 

Dr. A. A. Miner, Boston : It ap- 
pears to be a complete thesaurus of 
information on the drink problem. It 
is a work of extraordinary value. 
{^Sept. 6, 1884.) 

Rev. M. J. Savage, Boston: It 
seems to me a sort of distilled and con- 
centrated library. It aims — and, so 
far as I am wise enough to judge, suc- 
cessfully — to sum up the whole case 
for and against the use of alcohol. It 
appears to me impartial, and to use 
strong language only when amply war- 
ranted by facts. I wish this work might 
become a text-book in the schools. 
(Au^. 29, 1884.) 

Mrs. Mary A. Livermore, Fres. 
of the Woman's Christian Temperance 
Union : Here, at last, is a work on " the 
grave problem of alcohol and human 
life " which is exhaustive. 

The London Athenseum: It 
has, as far as we have tested it, the 
merit of accuracy. Mr. Gustafson has 
been fair in his selections, often repro- 
ducing passages which tell against his 
own convictions. We have not found 
any important book omitted from the 
admirable bibliography. 

The London School Board 
Chronicle : It would not be easy to 
overrate the value of the work in the 
hands of the teacher. 

Julius H. Seelye, Pres. Amherst 
Collesre, Mass. : I find the book a 



treasure-house of invaluable informa- 
tion on the various matters involved in 
what may be called the " Liquor Ques- 
tion." The remedial treatment of the 
evil is also amply considered, and I 
wish the book might be put into the 
hands of every teacher. 
(Sept. 17, 1884.) 

N. E, Journal of Education: 

This book exhausts the entire subject. 
The author has come to his conclusions 
with a force of reasoning that cannot 
fail to be convincing to every fair, hon- 
est, and unprejudiced mind. Its wide 
circulation will produce great good. 

Medical Temperance Journal, 

London : We are, as a medical journal, 
concerned with those portions of Mr. 
Gustafson's masterly production which 
more immediately relate to chemistry, 
physiology, and pathology, and here 
his main conclusions are sound, while 
his deductions are free from several 
errors which have appeared in many 
popular books on the science of tem- 
perance. 

John B. Gough : It impressed me 
with its fulness of treatment of the 
subject, its great research and labor, 
its sustained interest, and variety of 
fact and testimony. I wish they would 
all read it ; it leaves nothing to be said. 
(Dec. 23, 1884.) 

John G. Whittier : I have been 
reading with great interest and admira- 
tion Mr. Gustafson's masterly work. 
It is a treatise which entitles him to a 
high rank as a scholar and thinker, 
and to a place among the great bene- 
factors of mankind. (D^c. 11, 1884.) 

The N. Y. Tribune : It is the 
most thorough and careful study of the 
drink question that has appeared. 



MISCELLANEO US. 



Spring-field. Republican : Tem- 
perance literature is apt to be dis- 
counted more or less for its intensity 
and intolerance. It is refreshing to 
read such a broad, thoughtful, and 
learned survey of the whole subject as 
is given by Axel Gustafson. An inter- 
esting feature of his book is the genu- 
ine moral earnestness that accompanies 
his growing and more intelligent con- 
victions, based upon a thorough, com- 
prehensive, and fair-minded study of 
the subject from so many points of 
view. Whether one agrees with his 
deductions or not, the book is invalu- 
able as a comprehensive text-book, a 
"study" (in the best sense and from 
the English standpoint) which is as 
good as the best, a helpful thesaurus of 
the facts and literature of the whole 
subject. 

The Well Spring' : It is a book 
for the older members of the Sunday- 
school. 

The London Daily News : It is 

probably the most comprehensive and 
convincing survey of the drink ques- 
tion that has yet appeared. 

The Toronto {Can.:) Globe: It 
is one of the most noteworthy and val- 
uable additions to the literature of the 
alcohol question that has yet appeared. 

The Congregationalist, Boston : 
This treatise is the most comprehensive 
and serviceable which we remember to 
have seen. 

The Medical Press, London : 
We are not in the least surprised to 
hear that two large editions of this 
interesting work have already been 
sold. It will ultimately exert a pro- 
found influence over public opinion in 
this and every other civilized commu- 
nity. 



The Christian Register, Boston : 
No such thorough study of the drink 
question has ever been presented in 
the English language. 

The Liverpool {Eng.) Mercury: 
It is, perhaps, the most perfect sum- 
mary of all that has been said, or can 
be said, against the use of alcohol, 
which this generation is likely to see. 

The Universalist Quarterly, 

Boston : We are persuaded that it is 
the most complete presentation of the 
different aspects of the drink question 
ever brought together under one title. 

The Church Press, N.Y.: The 
present volume contains the fullest dis- 
cussion of this subject which can be 
found in any one book in the English 
language. 

The Daily Telegraph, London: 
This book will probably be the text- 
book of temperance reformers for a 
considerable period, as it is difficult to 
imagine the publication of a more 
conscientious work. 

Boston Herald : This is the first 
instance in which the subject has been 
treated in its length and breadth by a 
competent mind. No book on the 
drink question, at once so catholic, so 
practical, so useful, has before ap- 
peared. 

Boston Advertiser: It is the 
necessary handbook for all who have 
to deal with the drink question, whether 
they incline to one extreme or the 
other, and it discusses the subject with- 
out passion or prejudice. It practi- 
cally exhausts the subject, and its con- 
tents are easily accessible for reference 
or for the direction of further studies. 



Science. 



Guides for Science-Teaching. 

Published under the auspices of the Boston Society of Natural 
History. 

Intended for the use of teachers who desire to practically instruct 
their classes in Natural History, and designed to supply such infor- 
mation as they need in teaching and are not likely to get from any 
other source. 

Sets of Specimens illustrating Guides III. -VII. have been pre- 
pared and can be obtained at the following prices : — 

Guide III. (7 specimens), $i«). Guide VI. (12 specimens), $1.00. 

" IV., V. (15 specimens), $2.00. " VII. (10 specimens), $1.00. 

Larger collections, and sets for students' use, containing 10, 20, 
40, and 60 specimens of a single form can be obtained by special 
arrangement. 

Orders should be addressed to Samuel Henshaw, Boston Soct- 
ety of Natural History, Boston, Mass. 

These Guides were prepared solely as aids to teachers, — not as 
text-books. The plan of teaching followed throughout is based 
upon the assumption that, — 

Seeing is the first step on the road to knowledge ; that, — 

How much the child learns in his early years is of little impor- 
tance, — HOW he learns, everything ; that, — 

The teacher's work is not to teach the facts, but to lead the mind 
of each pupil to work out for itself the simple physical problems 
witnessed or described, and to cultivate the habit of observation and 
of perseverance in investigation. 

No. I. fiboui Pebbles. 

By Alphf.us Hyatt, Professor of Zoology and Paleontology in the 
Massachusetts Institute of Technology. i6ino. Paper. 26 pages. 
Mailing Price, 10 cents. 

This pamphlet is an illustration of the way in whi':h a common 
object may be used profitably in teaching. The paniphlet contains 
all the suggestions necessary to enable any teacher to make the 
lesson, or lessons, a complete success. 



SCIENCE. 

No. n. Concerning a Few Common Plants. 

By George Goodale, Professor of Botany in Harvard University. 
i6mo. Paper. 6i pages. Mailing Price, lo cents. 

This is complete in two parts (which are bound together), and 
gives an account of the organs or "helpful parts" of plants, and 
shows how these can be cultivated and used in the school-room for 
the mental training of children. The appliances recommended are 
of the most trifling cost. Even simple lenses are not absolutely 
required for any of the studies suggested. 



ISo. III. Commercial and Other Sponges. 

By Professor Alpheus Hyatt. Illustrated by "j plates. i6mo. Paper. 
43 pages. Mailing Price, 20 cents. 

This gives an account of the Sponges in common use, and of 
their structure, etc. The skeletons are present to the eye every 
day, and even the dullest scholar will undertake with interest to 
find out their different qualities, their common names, where they 
come from, and how they are formed. This little manual amply 
illustrates their processes of growth, and the methods of obtaining 
them and preparing them for the trade. 



:^o. lY. A First Lesson in Natural History. 

By Mrs. Elizabeth Agassiz. Illustrated by woodcuts and 4 plates. 
l6mo. Paper. 64 pages. Mailing Price, 25 cents. 

Gives, in narrative form, for very young children, a general his- 
tory of hydroids, corals, and echinoderms. Written under direction 
of Prof. Louis Agassiz. 

Scientifically accurate and clear, it is as simple and fascinating 
as a wonder sto^y. No fairies could more completely win the interest 
of children than do sea-anemones, corals, jelly-fishes, star-fishes, and 
sea-urchins, as described and depicted in this little book. 



GINN, HEA TH, &' CO.'S PUBLICA TIONS. 

No. Y. Common Hydroids, Corals, and Echinoderms. 

By Alphels Hyatt. lllnstraUd. 161110. Paper. 32 pages. Mail- 
ing Price, 20 cents. 

It begins with an account of the fresh-water hydroids, and shows 
throughout how the studies, or observations, are to be most satis- 
factorily made. The illustrations are remarkably clear and sugges- 
tive ; but, to teach the pupil the value of personal observation and a 
correct habit of study, nothing can take the place of specimens. It 
is desirable that those who are to use this Guide shall be able to 
refer to No. IV. of this series, which is frequently quoted. 



No. YI. Mollusca. Oyster, Clam, and Other Common Mollusks. 

By Alpheus Hyatt. Illustrated -loith ly plates containing ^j figures. 
i6mo. Paper. 65 pages. Mailing Price, 25 cents. 

Apart from its usefulness as holding in compact form all that 
need be taught beginners about the oyster, clam, and other common 
mollusks, this book is invaluable as illustrating in detail the natural 
method of teaching. From first to last, the pupil is a discoverer ; the 
teacher is simply the guide, — the pupil is self-taught. The author 
condescends to the simplest things, and tells in the plainest way 
just how to lead the class to make, in proper order, the necessary 
investigations and discoveries. The most inexperienced will be 
able, with this manual, to give these lessons with success. 



No. YII. \Norms and Crustacea. 

By Alpheits Hyatt. Illustrated. i6mo. Paper. 68 pages. Mail- 
ing Price, 25 cents. 

The space given to the description of the lobster (and fresh water 
crayfish) will, it is hoped, incite teachers to occupy more time iu 
dealing with some one common animal, and thus cultivating the 
habit of close observation. The specimens needed for the lessons 
upon worms are the common earth-worms and the Nercsis. In 
these lessons, as in the preceding, the children are to be discoverers, 
not mere learners, — they are to be taught by experience the value 
and the pleasure of direct personal observation. 



SCIENCE. 

!N"o. XII. Common Minerals and Rocks. 

By VV. O. Crosby, Instructor in Geology in the Massachusetts Institute 
of Technology. i6mo. 130 pages. Paper. Mailing Price, 25 cents. 

This includes, first, a brief and simple account of the principal 
geological agencies ; second, descriptions of about twenty minerals 
of which rocks are chiefly composed, and of all the more common and 
important varieties of rocks ; and, third, an explanation of the leading 
kinds of structure occurring in rocks, such as stratification, folds, 
faults, joints, etc. 

Especial prominence is given to the easy identification of the com- 
mon minerals and rocks, and to the constant association, in the mind, 
of the rocks and rock-structures with the agencies by which they have 
been formed. 

Complete sets of the specimens of minerals and rocks referred to 
in the Guide, aud enumerated in the Appendix, have been prepared 
by the author. Printed mmtbers, corresponditig to those in the list, 
are attached to the specimens. Price per set, $2.00. No charge 
for packing. Collections of one hundred specimens, somewhat 
larger in size, ajid all properly labelled, $5.00. 

All orders for specimens should be addressed to W. O. Crosby, 
Boston Society of Natural History, Corner of Berkeley and Boylston 
Streets, Boston, Mass. 

No. XIII. First Lessons in Minerals. 



By Ellen H. Richards, Instructor in Mineralogy, Mass. Institute 
Technology. i6mo. Paper. 50 pp. Mailing price, 10 cts. A valuable 
introduction to Guide No. XII. 

The outline of the lessons was first worked out by Mrs. Rich- 
ards with three successive classes of children, from six to eight 
years old, just out of the Kindergarten. The lessons were then 
given to classes in two public schools in the city of Boston. 
During the two years which have since elapsed, the lessons have 
been given to about one thousand children of the fourth classes of 
several of the Boston Grammar Schools. They have also been 
adopted by teachers in other places. Such changes have been made 
as experience has shown to be desirable, and it is presented there- 
fore in a form which can be recommended to teachers in general. 



GINN, HEATH, &' CO.'S PUBLICATIONS. 



Asa Grey, Prof, of Natural His- 
tory, Ha>~ciard Univ. : Teachers so 
taugiit sliouid be able to give " object 
lessons " to their young pupils with 
some success. Those who have not 
the advantage of such training should 
send for these primers, study them 
thoroughly, and follow the directions 
they give. 

Albert H. Tuttle, Prof Zoology, 
Ohio State Univ. : 1 wish to express 
my esteem for the whole series and the 
excellent work that Professors Goodale, 
Hyatt, and others are doing with them 
in Boston. 

Science Ne-ws, N.Y.: No. I. is 
quite as admirable in its way as Prof. 
Huxley's famous lecture " On a Piece 
of Chalk." We deem it embodying 
the most advanced ideas of how Nat- 
ural History ought to be and can be 
taught, which has long been a vexatious 
problem. 

The Evening' Post, N. Y. : They 
are executed in that spirit of direct 
common sense which best becomes 
every attempt to teach scientific truth. 
Properly used, they will work a revolu- 
tion in any school in which an atmos- 
phere of dulness prevails. 

Canada School Journal: The 

science of Natural History is in each 
case placed second to the science of 
teaching. They form for teachers who 
deserve the name the best possible 
reference-books on object-lessons. 

The Tutor, Baltimore, Md. : They 
are perfect little gems, full of sugges- 
tions, illustrations, and hints, useful to 
all who would like to learn the modes 
of presentation and study, or to be 
taught to observe with specimens. 



N. E. Journal of Education : 
This series of guides have been not 
only useful, but have become almost a 
necessity to teachers of elementary 
science. 

Chicago Advance : We venture 
to say that many persons, into whose 
hands the little book on " The Oyster, 
Clam, and other Mollusks" may fall, 
will find in it almost the first exact 
knowledge they have been able to ob- 
tain in regard to them. 

The Observer, N. Y. : Large num- 
bers of intelligent persons are such 
children in Natural Science that they 
would find these Guides the very books 
they need to prepare them for more 
advanced studies. Those who have 
no desire to pursue the subjects would 
find their interest in common things 
greatly enhanced by the perusal of 
these excellent little books. 

Canada Educational Monthly: 
Mrs. Richards' admirable pamphlet of 
fifty pages is well adapted for use in the 
higher classes of our public schools 
and junior classes in high schools. 
It would be difficult to improve upon it. 

The Critic: No XIII. is a tiny 
pamphlet, as admirable as it is tiny. 
It is based on the modern method of 
teaching, not by imparting, so much as 
by eliciting, information — questioning 
pupils, not for answers in the book, but 
for answers which they must think out 
for themselves, or investigate outside of 
their text-books. 

Utica Morning Herald : The 
care and accuracy with which it is 
done, together with the fuller treatment 
than usual in this series, make it a val- 
uable manual for those who wish to 
gain a general knowledge of the sub- 
ject without going into it too deeply. 



SCIENCE. 

First Book of Geology. 

By N. S. Shaler, Professor of Paleontology, Harvard University. 
272 pages, with 130 figures in the text. 74 pages additional in Teacher's 
Edition. Mailing price, ^i.io; Introduction, ^i.oo. 

The design of this first book in geology is to give the student 
of from ten to fifteen years of age a few clear, well-selected facts 
that may serve as a key to the knowledge of the earth. The num- 
ber of facts dealt with is far less than is usually given in such 
books, but pains is taken in their presentation to make them open 
the way to the broadest veins that the science affords. The effort 
is made to illustrate the principles of geology by reference to as 
many facts of familiar experience as possible. The first ]oart of the 
book treats of the simpler phenomena of a physical sort, the move- 
ments of the water and the air, and their effect on the machinery 
of the earth's surface ; then the simpler underground actions are 
taken up, such as the formation of veins, the folding of mountains, 
and the forces that lead to earthquakes and volcanoes. 

The latter half of the book is given to the history in outline of 
the earth's organic life. This is treated in a very general way, so as 
to show the student only the great steps of advance, and the 
method in which they are accomplished. 

In an appendix, to be used only when desired, is a brief account 
of certain more important mineral species, so arranged as to give 
the student an outline of mineralogy and some little idea of the 
common uses of minerals. 

The Teacher's Edition contains seventy-four pages of directions for 
those who use the book in class instruction. First there are some 
general directions for the guidance of teachers in their work in 
giving lessons on natural history, then each chapter of the book is 
taken up in turn, and the instructor is told how to supplement the 
lessons by reference to facts that may be easily accessible in the 
nature about the school. 

The Teacher's Edition will be found interesting by those who 
desire to get a glance at geology, and a general notion of its bear- 
ings on ordinary life. It is believed that these instructions will 
open a new field for the better use of the text-book in teaching 
geology. The instructor who will make proper use of these pages 



